CHA 2 DS 2 -VA score for predicting ventricular arrhythmias and mortality in ICD patients with ischemic heart disease and dilated cardiomyopathy: results from a prospective cohort.

Abstract

The revised CHA 2 DS 2 -VA score facilitates stroke risk assessment in patients with atrial fibrillation. This study investigates the value of the CHA 2 DS 2 -VA for prediction of all-cause and cardiovascular mortality and ventricular arrhythmia (VA) in patients with ischemic heart disease (IHD) and dilated cardiomyopathy (DCM) undergoing implantable cardioverter-defibrillator (ICD) therapy. We analyzed data from 1,626 ICD recipients with IHD ( n = 1,225) or DCM ( n = 401) enrolled in a prospective registry at University Hospital Basel. Patients were stratified into low and high CHA 2 DS 2 -VA groups based on median score within each condition. Mortality and VA outcomes were assessed using Kaplan-Meier survival analysis and Cox proportional hazards models. The median CHA 2 DS 2 -VA was 3 overall, 2 in DCM, and 4 in IHD patients. During a median follow-up of 7.5 years, 46% died, with an all-cause mortality rate of 6.1 per 100 patient-years. Higher CHA 2 DS 2 -VA scores were associated with increased all-cause and cardiovascular mortality in both IHD (HR 2.36, 95% CI 1.99-2.80, p < 0.001 for all-cause death) and DCM (HR 1.98, 95% CI 1.44-2.73, p < 0.001 for all-cause death). Each one-point increase in CHA 2 DS 2 -VA increased mortality risk (HR 1.4, 95% CI 1.34-1.47, p < 0.001 for all-cause death). No association was observed between CHA 2 DS 2 -VA and VA occurrence in the overall cohort or subgroups. The CHA 2 DS 2 -VA is strongly associated with all-cause and cardiovascular mortality in ICD patients with IHD and DCM, but does not predict VA. Thus, it may aid in mortality risk stratification but should not be used as a primary tool for arrhythmic risk assessment.