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- Title
R<sub>2(GFR)</sub>CHADS<sub>2</sub> and R<sub>2(GFR)</sub>CHA<sub>2</sub>DS<sub>2</sub>VASc schemes improved the performance of CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>VASc scores in death risk stratification of Chinese older patients with atrial fibrillation
- Authors
Shihui Fu; Shanjing Zhou; Leiming Luo; Ping Ye
- Abstract
Background: This analysis was carried out to refine the CHADS2 and CHA2DS2VASc scores by combining creatinine clearance (CrCl) and glomerular filtration rate (GFR) and evaluate the performance of CrCl-based and GFR-based schemes in death risk stratification of Chinese older patients with atrial fibrillation (AF). Methods: There were 219 older patients with AF, and all-cause mortality was assessed during the follow-up of 1.11 years. Renal function was evaluated using the CrCl formula and different GFR (Modification of Diet in Renal Disease [MDRD], Chinese MDRD [CMDRD], Mayo Clinic Quadratic [Mayo] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) formulas, and five kinds of R2CHADS2 and R2CHA2DS2VASc schemes were generated by combining CrCl and GFR with CHADS2 and CHA2DS2VASc scores. Results: In Cox regression multivariate analysis, CrCl, 60 mL/min was moderately associated with death risk (P=0.122 and P=0.144). When MDRD, CMDRD, CKD-EPI and Mayo formulas were used to ascertain the GFR, GFR, 60 mL/min/1.73 m² was significantly associated with death risk (P<0.001 for all). In the models with CHADS2 and CHA2DS2VASc scores as the linear covariates, CrCl and GFR as the continuous variables were significantly associated with death risk (P<0.05 for all). C-statistics of CrCl-based schemes - R2(CrCl)CHADS2 and R2(CrCl) CHA2DS2VASc - moderately exceeded that of CHADS2 and CHA2DS2VASc scores (P=0.081 and 0.082). C-statistics of GFR-based schemes - R2(GFR)CHADS2 and R2(GFR)CHA2DS2VASc - significantly exceeded that of CHADS2 and CHA2DS2VASc scores (P<0.05 for all). Conclusion: Chinese older patients with AF with lower levels of GFR and GFR, 60 mL/min/1.73 m² had a significantly high death risk, and those with lower levels of CrCl or CrCl, 60 mL/min had a significantly or modestly high death risk. There was significantly better performance of GFR-based schemes and moderately better performance of CrCl-based schemes in death risk stratification compared with CHADS2 and CHA2DS2VASc scores.
- Subjects
CHINA; ATRIAL fibrillation treatment; GLOMERULAR filtration rate; OLDER people
- Publication
Clinical Interventions in Aging, 2017, Vol 12, p1233
- ISSN
1178-1998
- Publication type
Article
- DOI
10.2147/CIA.S138405