Assessment of the CHA<sub>2</sub>DS<sub>2</sub>-VASc Score in Predicting Mortality and Adverse Cardiovascular Outcomes of Patients on Hemodialysis
Miri Schamroth Pravda, Keren Cohen‐Hagai, Guy Topaz, Nili Schamroth Pravda, Nadeen Makhoul, Mony Shuvy, Sydney Benchetrit, Abid Assali, David Pereg
Abstract
<b><i>Background:</i></b> Patients with end-stage renal disease (ESRD) undergoing chronic hemodialysis are at high mortality and cardiovascular risk. This study was aimed to assess whether the CHA<sub>2</sub>DS<sub>2</sub>-VASc score may be used for risk stratification of this population. <b><i>Methods:</i></b> Included were patients undergoing chronic hemodialysis at Meir Medical Center. The CHA<sub>2</sub>DS<sub>2</sub>-VASc score was calculated for each patient at the initiation of hemodialysis. Patients were classified into 3 groups according to the CHA<sub>2</sub>DS<sub>2</sub>-VASc score: 0–3 (low), 4–5 (intermediate), and ≥6 (high). The primary endpoint was the composite of all-cause mortality, myocardial infarction, and stroke during the first year of hemodialysis. <b><i>Results:</i></b> Of the 457 patients with ESRD, 181 (40%) had low, 193 (42%) intermediate, and 83 (18%) high CHA<sub>2</sub>DS<sub>2</sub>-VASc scores. During the first year of hemodialysis, 109 (23.8%) patients died, 17 (3.7%) had a stroke, and 28 (6.1%) had a myocardial infarction. Compared to patients in the low CHA<sub>2</sub>DS<sub>2</sub>-VASc score group, those in the intermediate and high score groups had higher risk for the composite endpoint (OR: 2.6, 95% CI: 1.6–4.2, <i>p</i> &#x3c; 0.01 and OR: 4.2, 95% CI: 2.3–7.5, <i>p</i> &#x3c; 0.01, respectively). Each 1-point increase in CHA<sub>2</sub>DS<sub>2</sub>-VASc score was associated with a 38% increased risk for the composite endpoint, a 19% increased risk for 1-year myocardial infarction, and a 29% increased risk for 1-year stroke. <b><i>Conclusions:</i></b> Patients with ESRD are at an extremely high mortality and cardiovascular risk within the first year of hemodialysis. The CHA<sub>2</sub>DS<sub>2</sub>-VASc score was strongly associated with adverse outcomes and may be used for risk stratification of these patients.