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. 2023 Sep 16;2(8):100609.
doi: 10.1016/j.jacadv.2023.100609. eCollection 2023 Oct.

Outcomes and Discriminatory Accuracy of the CHA2DS2VASc Score in Atrial Fibrillation and Cancer

Waqas Ullah  1 , Mathew DiMeglio  1 , Daniel R Frisch  1 , Rodrigo Bagur  2 , Louise Y Sun  3 , David L Fischman  1 , Andrija Matetic  4 , Bonnie Ky  5 , Mamas A Mamas  1   6
Affiliations

Outcomes and Discriminatory Accuracy of the CHA2DS2VASc Score in Atrial Fibrillation and Cancer

Waqas Ullah et al. JACC Adv. .

Abstract

Background: Atrial fibrillation (AF) is highly prevalent among cancer patients. The role of traditional risk stratification scores in the context of different cancer types in these patients remains unknown.

Objectives: The purpose of this study was to determine the discriminative accuracy of the CHA2DS2VASc score for ischemic stroke using receiver operating characteristic and area under the curve.

Methods: The National Readmission Database (2015-2019) was used to identify all AF patients stratified by the cancer diagnosis, type, and CHA2DS2VASc category (low; moderate; high risk). Outcomes at 30-day readmission were compared between cancer and noncancer groups using hierarchical multivariable logistic regression to calculate adjusted odds ratios (aORs) and 95% CIs.

Results: A total of 6,996,088 AF patients were identified at index admission. Of these, 4,242,630 (642,237 cancer, 3,600,393 noncancer) were readmitted at 30 days. Cancer patients (92.1%) had a higher proportion of high CHA2DS2VASc scores compared with their noncancer counterparts (89.8%, P < 0.001). The 30-day readmission rate and incidence of major bleeding in cancer patients were significantly higher compared with their corresponding noncancer group across all CHA2DS2VASc categories. Among the different cancer types, hematological and lung cancer had a high propensity for major bleeding. The odds of ischemic stroke were lower in the cancer group across high (1.9% vs 2.4%; aOR: 0.78; 95% CI: 0.76-0.79; P < 0.0001), moderate (0.8% vs 1.3%; aOR: 0.57; 95% CI: 0.50-0.64; P < 0.0001), and low (0.4% vs 0.9%; aOR: 0.46; 95% CI: 0.34-0.62; P < 0.0001) risk category relative to the noncancer group irrespective of type of cancer. CHA2DS2VASc category had a statistically significant discriminatory accuracy for ischemic stroke in both cancer and noncancer patients.

Conclusions: Cancer patients with AF are at a higher risk of readmission and major bleeding. The risk of ischemic stroke during readmission appears to be lower than noncancer patients. These findings may have implications for anticoagulant therapy in cancer patients.

Keywords: anticoagulation; atrial fibrillation; bleeding; stroke.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Proportion of Patients With Each CHA2DS2VASc Score Category by Cancer Type
Figure 2
Figure 2
Evaluation of the CHA2DS2VASc Risk Score Components Based on Cancer Status CHF = congestive heart failure; DM = diabetes mellitus; HTN = hypertension.
Central Illustration
Central Illustration
30-Day Outcomes and Discriminatory Accuracy of the CHA2DS2VASc Score in Patients With Atrial Fibrillation and Concomitant Cancer
See this image and copyright information in PMC

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