CHA2DS2-VASc Score in Patients With Atrial Fibrillation and Cancer: A U.S. Nationwide Study

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-04-23 DOI:10.1016/j.amjcard.2025.04.025

Mohammad AL Mouslmani MD, MPH , Mohamad Alhoda Alahmad MD , Zafer Akman MD , Raiza Rossi MD , Mufti Rahman MD, MSc, MPH , Michael G. Nanna MD, MHS

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引用次数: 0

Abstract

The CHA₂DS₂-VASc score is widely accepted as the most reliable tool for risk stratification to guide the initiation of anticoagulation in patients with atrial fibrillation/flutter. However, it has not been validated for use in patients with malignancy, and lacks cancer-related parameters. We aimed to evaluate the CHA₂DS₂-VASc score’s association with acute cerebrovascular accident (CVA) in cancer patients during hospitalization for atrial fibrillation/flutter in the United States. We conducted a cross-sectional analysis of the Nationwide Readmissions Database (NRD) from 2016 to 2019, extracting all cases with a primary diagnosis of atrial fibrillation/flutter. We then divided all patients based on the presence or absence of malignancy and calculated CHA₂DS₂-VASc scores. We identified 1,769,603 weighted admissions with atrial fibrillation/flutter, of those, 96,982 had malignancy. The cohort with malignancy had a mean age of 74 years (SD, 13.4) vs 70.4 years (SD, 17.8). In both cohorts, each additional point in the CHA₂DS₂-VASc score was associated with higher odds of acute CVA during index hospitalization. For the cohort with malignancy, a score of 2 (compared to 0) was associated with an odds ratio (OR) of 4.73 (1.71 to 13.10) compared with 2.61 (2.08 to 3.27) for the cohort without malignancy. In conclusion, the CHA₂DS₂-VASc score was linearly associated with acute CVA in patients with atrial fibrillation/flutter with and without cancer. However, the odds ratios were higher in the cohort with malignancy, emphasizing the importance of anticoagulation initiation in patients with cancer.

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房颤和癌症患者的CHA2DS2-VASc评分：一项美国全国性研究

CHA2DS2-VASc评分被广泛认为是指导心房颤动/扑动患者开始抗凝治疗的最可靠的风险分层工具。然而，它尚未被证实用于恶性肿瘤患者，并且缺乏与癌症相关的参数。我们的目的是评估CHA₂DS₂-VASc评分与美国因心房颤动/扑动住院的癌症患者急性脑血管事故（CVA）的关系。我们对2016年至2019年全国再入院数据库（NRD）进行了横断面分析，提取了所有初步诊断为心房颤动/扑动的病例。然后，我们根据是否存在恶性肿瘤对所有患者进行分组，并计算CHA₂DS₂-VASc评分。我们确定了1,769,603例心房颤动/扑动加权入院，其中96,982例为恶性。恶性肿瘤患者的平均年龄为74岁（SD, 13.4） vs 70.4岁（SD, 17.8）。在这两个队列中，CHA₂DS₂-VASc评分每增加一点，在指数住院期间发生急性CVA的几率就会增加。对于恶性肿瘤队列，2分（与0分相比）与比值比（OR）相关，比值比为4.73(1.71至13.10)，而对于无恶性肿瘤队列，比值比为2.61（2.08至3.27）。总之，CHA₂DS₂-VASc评分与伴有和不伴有癌症的心房颤动/扑动患者的急性CVA呈线性相关。然而，在恶性肿瘤队列中，优势比更高，强调了癌症患者开始抗凝治疗的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.