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  • Title: The CHA2DS2-VASc score strongly correlates with glomerular filtration rate and predicts renal function decline over time in elderly patients with atrial fibrillation and chronic kidney disease.
    Author: Beyer-Westendorf J, Kreutz R, Posch F, Ay C.
    Journal: Int J Cardiol; 2018 Feb 15; 253():71-77. PubMed ID: 29306476.
    Abstract:
    BACKGROUND: The decline of renal function affects stroke risk in patients with atrial fibrillation (AF). Here, we aim to study the predictive value of the CHA2DS2-VASc score, a stroke-risk stratification model in AF, for renal function and renal decline in patients with AF and chronic kidney disease (CKD). METHODS: Two electronic health record cohorts with AF and CKD stage III/IV were evaluated (Cohort #1 (IMS-DA, Germany): 18,539 patients with 125,149 estimated glomerular filtration rate (eGFR) measurements; Cohort #2 (IMS-THIN, United Kingdom): 18,240 patients with 133,676 eGFR measurements). The eGFR trajectories were analysed with multi-level mixed-effects regression and joint models for longitudinal and survival data. RESULTS: In IMS-DA, the mean baseline eGFR was 52.0ml/min/1.73m2, and declined by 1.03ml/min/1.73m2/year (95%CI: 0.86-1.19, p<0.0001). In IMS-THIN, the mean baseline eGFR was 48.0ml/min/1.73m2, and declined by 0.44ml/min/1.73m2/year (95%CI: 0.37-0.51, p<0.0001). In both datasets, higher CHA2DS2-VASc scores (median: 4 points) were strongly associated with both lower baseline eGFR (p<0.0001) and faster progression of CKD (p=0.002). Mean baseline eGFR values were higher in patients with a CHA2DS2-VASc score of 0 compared to patients with a score of 8 points. Conversely, the annual declines in eGFR were lower in patients with a score of 0 compared to patients with a score of 8 points in both databases. CONCLUSION: The CHA2DS2-VASc score can identify AF patient subgroups with lower baseline eGFR and a higher risk of CKD progression, which has important implications for the management of anticoagulation in these patients.
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