
All subgroups of patients with atrial fibrillation (AF) with a CHA2DS2-VASc score of 1, compared with patients aged at least 75 years without other risk factors, are associated with lower incidence of arterial thromboembolism. However, when compared with patients with a CHA2DS2-VASc score of 0, there is higher incidence. These findings were published in Circulation.
Investigators in Denmark sought to evaluate granular differences within CHA2DS2-VASc 1 scores by examining the incidence of arterial thromboembolism according to CHA2DS2-VASc 1 subgroups. The primary outcome was arterial thromboembolism (transient cerebral ischemia, embolism of extremity, ischemic stroke).
The investigators used data from the Danish National Patient Registry and the Danish Prescription Registry to conduct a nationwide observational study identifying patients in Denmark with AF from 2000 to 2021 who were not receiving oral anticoagulation therapy (ICD-10 codes). Patients were stratified according to CHA2DS2-VASc score (CHA2DS2-VASc 0; CHA2DS2-VASc 1; CHA2DS2-VASc 2 [age ≥75 years without other risk factors]). No risk group considered female sex as a risk factor.
Patients with a mechanical heart valve, prior arterial thromboembolism, prior venous thromboembolism, or oral anticoagulant treatment around AF diagnosis were excluded, as were those with CHA2DS2-VASc scores greater than 1 (except those at least 75 years of age).
The investigators found 26,701 patients with a CHA2DS2-VASc score of 0 (62.6% men), 22,915 patients with a CHA2DS2-VASc score of 1, and 14,525 patients with a CHA2DS2-VASc score of 2.
Overall, the majority of patients were men. Aspirin use was higher among patients with a CHA2DS2-VASc score of 1 (64.4%) and lowest for those with a CHA2DS2-VASc score of 0 (12.8%). Median observation time was 365 days for the overall study sample. Non-statistically significant differences were noted between men and women for incidence of arterial thromboembolism in all groups (CHA2DS2-VASc 0 group, 0.6% women vs 0.7% men; CHA2DS2-VASc 1 group, 1.8% women vs 2.2% men; CHA2DS2-VASc 2 group, 4.6% women vs 4.1% men).
The investigators noted the cumulative incidence of arterial thromboembolism was the following:
- 0.6% for patients with a CHA2DS2-VASc score of 0 (95% CI, 0.6%-0.8%)
- 1.4% for patients with a CHA2DS2-VASc score of 1 with heart failure (95% CI, 0.8%-2.2%)
- 1.9% for patients with a CHA2DS2-VASc score of 1 with hypertension (95% CI, 1.6%-2.2%)
- 1.7% for patients with a CHA2DS2-VASc score of 1 with diabetes (95% CI, 0.9%-2.9%)
- 2.0% for patients with a CHA2DS2-VASc score of 1 with vascular disease (95% CI, 1.1%-3.4%)
- 2.3% for patients with a CHA2DS2-VASc score of 1 aged 65 to 74 years (95% CI, 2.0%-2.7%)
- 4.4% for patients with a CHA2DS2-VASc score of 2 (95% CI, 4.1%-4.8%)
Among subgroups of the CHA2DS2-VASc 1 group, the investigators found no statistically significant difference (Pdifference =.15).
Study limitations include possible misclassification of ICD-10 codes, lack of generalizability to other ethnic groups, the observational design not defining causality, and underpowered sample sizes in some subgroups of CHA2DS2-VASc 1.
“For patients with atrial fibrillation, all subgroups of CHA2DS2-VASc 1 were associated with lower incidence of arterial thromboembolism compared with age 75 years [or older] without other risk factors (ie, CHA2DS2-VASc 2) and a higher incidence compared with CHA2DS2-VASc 0,” the investigators wrote. “No statistically significant difference was identified between the subgroups of CHA2DS2-VASc 1.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
This article originally appeared on The Cardiology Advisor
References:
Østergaard L, Olesen JB, Petersen JK, et al. Arterial thromboembolism in patients with atrial fibrillation and CHA2DS2-VASc 1: a nationwide study. Circulation. Published online December 28, 2023. doi:10.1161/CIRCULATIONAHA.123.066477