Thromboembolic risk stratification of patients hospitalized with heart failure in sinus rhythm: a nationwide cohort study

Emil Wolsk; Morten Lamberts; Morten L. Hansen; Paul Blanche; Lars Køber; Christian Torp-Pedersen; Gregory Y. H. Lip; Gunnar Gislason

doi:10.1002/ejhf.309

Thromboembolic risk stratification of patients hospitalized with heart failure in sinus rhythm: a nationwide cohort study

Emil Wolsk, Morten Lamberts, Morten L. Hansen, Paul Blanche, Lars Køber, Christian Torp-Pedersen, Gregory Y. H. Lip, Gunnar Gislason

25 Citations (Scopus)

Abstract

AIMS: Patients with heart failure in sinus rhythm are at an increased risk of thromboembolic complications. So far, validated risk stratification tools are lacking for such patients, which makes the decision to initiate anti-thrombotic treatment difficult.

METHODS AND RESULTS: We included 136,545 patients admitted with heart failure in sinus rhythm from national registries from 1999 to 2012. Patients receiving oral anticoagulants were omitted from the study. First, we investigated if the CHA2DS2-VASc score could identify heart failure patients in sinus rhythm with high rates of thromboembolic complications. Second, we investigated if any single CHA2DS2-VASc risk factor carried a greater prognostic value with regard to thromboembolism. The risk of thromboembolism increased more than ninefold (hazard ratio 9.2, 95% confidence interval 6.8-12.5) in patients with all CHA2DS2-VASc risk factors compared with those with heart failure alone. The incidence rates of thromboembolism were clinically significant, averaging 6.0 (95% confidence interval 5.98-6.02) events per 100 patient years during the first year following diagnosis. Risk factors such as diabetes, age, vascular disease, and especially previous thromboembolism, conferred an independent risk of future thromboembolism.

CONCLUSION: The CHA2DS2-VASc risk stratification scheme was able to provide prognostic information on future thromboembolic events in patients with heart failure in sinus rhythm. The CHA2DS2-VASc scale could be easily implemented as an aid to clinicians in risk stratifying heart failure patients in sinus rhythm, for thromboembolism.

Original language	English
Journal	European Journal of Heart Failure
Volume	17
Issue number	8
Pages (from-to)	828-836
Number of pages	9
ISSN	1388-9842
DOIs	https://doi.org/10.1002/ejhf.309
Publication status	Published - 1 Aug 2015

Keywords

Age Factors
Aged
Aged, 80 and over
Cohort Studies
Diabetes Complications
Female
Forecasting
Heart Failure
Hospitalization
Humans
Hypertension
Male
Middle Aged
Prognosis
Risk
Risk Factors
Sex Factors
Thromboembolism
Vascular Diseases

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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title = "Thromboembolic risk stratification of patients hospitalized with heart failure in sinus rhythm: a nationwide cohort study",

abstract = "AIMS: Patients with heart failure in sinus rhythm are at an increased risk of thromboembolic complications. So far, validated risk stratification tools are lacking for such patients, which makes the decision to initiate anti-thrombotic treatment difficult.METHODS AND RESULTS: We included 136,545 patients admitted with heart failure in sinus rhythm from national registries from 1999 to 2012. Patients receiving oral anticoagulants were omitted from the study. First, we investigated if the CHA2DS2-VASc score could identify heart failure patients in sinus rhythm with high rates of thromboembolic complications. Second, we investigated if any single CHA2DS2-VASc risk factor carried a greater prognostic value with regard to thromboembolism. The risk of thromboembolism increased more than ninefold (hazard ratio 9.2, 95% confidence interval 6.8-12.5) in patients with all CHA2DS2-VASc risk factors compared with those with heart failure alone. The incidence rates of thromboembolism were clinically significant, averaging 6.0 (95% confidence interval 5.98-6.02) events per 100 patient years during the first year following diagnosis. Risk factors such as diabetes, age, vascular disease, and especially previous thromboembolism, conferred an independent risk of future thromboembolism.CONCLUSION: The CHA2DS2-VASc risk stratification scheme was able to provide prognostic information on future thromboembolic events in patients with heart failure in sinus rhythm. The CHA2DS2-VASc scale could be easily implemented as an aid to clinicians in risk stratifying heart failure patients in sinus rhythm, for thromboembolism.",

keywords = "Age Factors, Aged, Aged, 80 and over, Cohort Studies, Diabetes Complications, Female, Forecasting, Heart Failure, Hospitalization, Humans, Hypertension, Male, Middle Aged, Prognosis, Risk, Risk Factors, Sex Factors, Thromboembolism, Vascular Diseases",

author = "Emil Wolsk and Morten Lamberts and {L. Hansen}, Morten and Paul Blanche and Lars K{\o}ber and Christian Torp-Pedersen and Lip, {Gregory Y. H.} and Gunnar Gislason",

note = "{\textcopyright} 2015 The Authors. European Journal of Heart Failure {\textcopyright} 2015 European Society of Cardiology.",

year = "2015",

month = aug,

day = "1",

doi = "10.1002/ejhf.309",

language = "English",

volume = "17",

pages = "828--836",

journal = "European Journal of Heart Failure, Supplement",

issn = "1567-4215",

publisher = "JohnWiley & Sons Ltd",

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TY - JOUR

T1 - Thromboembolic risk stratification of patients hospitalized with heart failure in sinus rhythm

T2 - a nationwide cohort study

AU - Wolsk, Emil

AU - Lamberts, Morten

AU - L. Hansen, Morten

AU - Blanche, Paul

AU - Køber, Lars

AU - Torp-Pedersen, Christian

AU - Lip, Gregory Y. H.

AU - Gislason, Gunnar

PY - 2015/8/1

Y1 - 2015/8/1

N2 - AIMS: Patients with heart failure in sinus rhythm are at an increased risk of thromboembolic complications. So far, validated risk stratification tools are lacking for such patients, which makes the decision to initiate anti-thrombotic treatment difficult.METHODS AND RESULTS: We included 136,545 patients admitted with heart failure in sinus rhythm from national registries from 1999 to 2012. Patients receiving oral anticoagulants were omitted from the study. First, we investigated if the CHA2DS2-VASc score could identify heart failure patients in sinus rhythm with high rates of thromboembolic complications. Second, we investigated if any single CHA2DS2-VASc risk factor carried a greater prognostic value with regard to thromboembolism. The risk of thromboembolism increased more than ninefold (hazard ratio 9.2, 95% confidence interval 6.8-12.5) in patients with all CHA2DS2-VASc risk factors compared with those with heart failure alone. The incidence rates of thromboembolism were clinically significant, averaging 6.0 (95% confidence interval 5.98-6.02) events per 100 patient years during the first year following diagnosis. Risk factors such as diabetes, age, vascular disease, and especially previous thromboembolism, conferred an independent risk of future thromboembolism.CONCLUSION: The CHA2DS2-VASc risk stratification scheme was able to provide prognostic information on future thromboembolic events in patients with heart failure in sinus rhythm. The CHA2DS2-VASc scale could be easily implemented as an aid to clinicians in risk stratifying heart failure patients in sinus rhythm, for thromboembolism.

AB - AIMS: Patients with heart failure in sinus rhythm are at an increased risk of thromboembolic complications. So far, validated risk stratification tools are lacking for such patients, which makes the decision to initiate anti-thrombotic treatment difficult.METHODS AND RESULTS: We included 136,545 patients admitted with heart failure in sinus rhythm from national registries from 1999 to 2012. Patients receiving oral anticoagulants were omitted from the study. First, we investigated if the CHA2DS2-VASc score could identify heart failure patients in sinus rhythm with high rates of thromboembolic complications. Second, we investigated if any single CHA2DS2-VASc risk factor carried a greater prognostic value with regard to thromboembolism. The risk of thromboembolism increased more than ninefold (hazard ratio 9.2, 95% confidence interval 6.8-12.5) in patients with all CHA2DS2-VASc risk factors compared with those with heart failure alone. The incidence rates of thromboembolism were clinically significant, averaging 6.0 (95% confidence interval 5.98-6.02) events per 100 patient years during the first year following diagnosis. Risk factors such as diabetes, age, vascular disease, and especially previous thromboembolism, conferred an independent risk of future thromboembolism.CONCLUSION: The CHA2DS2-VASc risk stratification scheme was able to provide prognostic information on future thromboembolic events in patients with heart failure in sinus rhythm. The CHA2DS2-VASc scale could be easily implemented as an aid to clinicians in risk stratifying heart failure patients in sinus rhythm, for thromboembolism.

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Cohort Studies

KW - Diabetes Complications

KW - Female

KW - Forecasting

KW - Heart Failure

KW - Hospitalization

KW - Humans

KW - Hypertension

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Risk

KW - Risk Factors

KW - Sex Factors

KW - Thromboembolism

KW - Vascular Diseases

U2 - 10.1002/ejhf.309

DO - 10.1002/ejhf.309

M3 - Journal article

C2 - 26136386

SN - 1567-4215

VL - 17

SP - 828

EP - 836

JO - European Journal of Heart Failure, Supplement

JF - European Journal of Heart Failure, Supplement

IS - 8

ER -

Thromboembolic risk stratification of patients hospitalized with heart failure in sinus rhythm: a nationwide cohort study

Abstract

Keywords

UN SDGs

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