CHADS2 and CHA2DS2-VASc score to assess risk of stroke and death in patients paced for sick sinus syndrome
- Jesper Hastrup Svendsen1,2,3,
- Jens Cosedis Nielsen4,
- Stine Darkner1,
- Gunnar Vagn Hagemann Jensen5,
- Leif Spange Mortensen6,
- Henning Rud Andersen4,
- on behalf of the DANPACE Investigators
- 1Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 2The Danish National Research Foundation Centre for Cardiac Arrhythmia, Copenhagen, Denmark
- 3Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- 4Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
- 5Department of Cardiology, Roskilde Hospital, Copenhagen University Hospital, Roskilde, Denmark
- 6UNI-C, Aarhus, Denmark
- Correspondence to Professor Jesper Hastrup Svendsen, Department of Cardiology, Rigshospitalet, Section 2013, Blegdamsvej 9, Copenhagen DK-2100, Denmark;
- Received 23 January 2013
- Revised 22 February 2013
- Accepted 25 February 2013
- Published Online First 28 March 2013
Objective The risk of stroke in patients with atrial fibrillation (AF) can be assessed by use of the CHADS2 and the CHA2DS2-VASc score system. We hypothesised that these risk scores and their individual components could also be applied to patients paced for sick sinus syndrome (SSS) to evaluate risk of stroke and death.
Design Prospective cohort study.
Settings All Danish pacemaker centres and selected centres in the UK and Canada.
Patients Risk factors were recorded prior to pacemaker implantation in 1415 patients with SSS participating in the Danish Multicenter Randomized Trial on Single Lead Atrial Pacing versus Dual Chamber Pacing in Sick Sinus Syndrome (Danpace) trial. Development of stroke was assessed at follow-up visits and by evaluation of patient charts. Mortality was assessed from the civil registration system.
Interventions Patients were randomised to AAIR (N=707) or DDDR pacing (N=708).
Main outcome measures Stroke and death during follow-up.
Results Mean follow-up was 4.3±2.5 years. In the AAIR group 6.9% patients developed stroke versus 6.1% in the DDDR group (NS). There was a significant association between CHADS2 score and the development of stroke (HR 1.41; 95% CI 1.22 to 1.64, p<0.001). CHA2DS2-VASc score was also significantly associated with stroke (HR 1.25; CI 1.12 to 1.40, p<0.001). CHADS2 score (HR 1.46; CI 1.36 to 1.56, p<0.001) and CHA2DS2-VASc score (HR 1.39; CI 1.31 to 1.46, p<0.001) were associated with mortality. Results were still significant after adjusting for AF and anticoagulation therapy.
Conclusions CHADS2 and CHA2DS2-VASc score are associated with increased risk of stroke and death in patients paced for SSS irrespective of the presence of AF.
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