| Background:Heart failure is a complex clinical syndrome caused by various cardiovascular diseases that result in abnormal heart structure or function,leading to difficulty breathing during exertion,nocturnal paroxysmal dyspnea,bilateral lower limb edema,and other symptoms and signs caused by ventricular systolic and/or diastolic dysfunction.Atrial fibrillation is a common arrhythmia.Atrial fibrillation and heart failure are two of the biggest challenges of the 21st century,both of which are age-related and have increasing incidence with age.The CHA2DS2-VASc scoring system is currently the most commonly used stroke risk assessment score for atrial fibrillation,and can also predict mortality in heart failure.However,the CHA2DS2-VASc score does not take into account renal function indicators,which are important predictors of stroke in the atrial fibrillation population and independent predictors of mortality and worsening heart failure in patients with heart failure.The R2CHA2DS2-VASc score adds 2 points to the CHA2DS2-VASc score in situations where the estimated glomerular filtration rate is<60 ml/min/1.73m~2,further increasing its predictive value for prognosis.Objectives:This study aims to explore and compare the prognostic evaluation of R2CHA2DS2-VASc and CHA2DS2-VASc scores in non-valvular atrial fibrillation combined with heart failure.Methods:A total of 256 patients with non-valvular atrial fibrillation combined with heart failure who were first admitted to the cardiovascular department of the First Affiliated Hospital of Guangzhou Medical University between January 1,2019 and December31,2021 were included in this study.General clinical data,laboratory and imaging examination results,and discharge medication information were collected.A retrospective follow-up was conducted for one year from the day of discharge with the occurrence of major adverse cardiac events(MACE)as the end point,which was defined as rehospitalization due to heart failure and all-cause mortality.According to the occurrence of MACE events,patients were divided into two groups:the MACE group and the non-MACE group.The CHA2DS2-VASc score was divided into three risk groups based on score points:low-risk group(1-3 points),intermediate-risk group(4-6 points),and high-risk group(>6 points).The R2CHA2DS2-VASc score was also divided into three risk groups based on score points:low-risk group(1-3 points),intermediate-risk group(4-6 points),and high-risk group(>6 points).The clinical baseline data of patients in the MACE group and the non-MACE group were compared using SPSS 22 software.Logistic regression analysis was used to analyze the risk factors associated with MACE events in patients with non-valvular atrial fibrillation combined with heart failure.Receiver operating characteristic(ROC)curves and the area under the curve(AUC)were used to compare the predictive value of the CHA2DS2-VASc and R2CHA2DS2-VASc scores for MACE events and were compared using Med Calc software.A P-value less than 0.05 was considered statistically significant.Results:There were 114 cases in the MACE event group and 142 cases in the non-MACE event group.There were differences between the two groups in NYHA heart function classification,NT-pro BNP,creatinine,CHA2DS2-VASc score,R2CHA2DS2-VASc score,glomerular filtration rate,blood sodium,blood calcium and use of diuretics and lipid-lowering drugs(P<0.05).The MACE event group had older age,higher proportion of NYHA heart function III and IV levels,poorer kidney function,higher CHA2DS2-VASc score and R2CHA2DS2-VASc score,lower blood sodium and calcium levels,more use of diuretics and less use of lipid-lowering drugs.The incidence of MACE events was positively correlated with low,medium and high risk R2CHA2DS2-VASc scores.The number of MACE events in patients with renal insufficiency increased significantly.Univariate logistic analysis showed that age≥75 years(OR=2.014,95%CI1.194-3.396,P=0.009),NYHA functional class(OR=1.713,95%CI 1.201-2.443,P=0.003),NT-pro BNP>1800 pg/ml(OR=3.110,95%CI 1.799-5.378,P<0.001),use of diuretics(OR=2.615,95%CI 1.250-5.472,P=0.011),CHA2DS2-VASc score(OR=1.231,95%CI 1.055-1.435,P=0.008)and R2CHA2DS2-VASc score(OR=1.219,95%CI 1.078-1,378,P=0.002)were risk factors for MACE events in patients with non-valvular atrial fibrillation and heart failure.Increased e GFR(OR=0.981,95%CI0.968-0.994,P=0.004),serum sodium(OR=0.939,95%CI 0.889-0.993,P=0.027)and use of lipid-lowering drugs were protective factors.Multivariate logistic regression analysis was performed with all the variables except the two scores from the univariate logistic regression analysis.The results showed that NT-pro BNP>1800 pg/ml(OR=2.371,95%CI 1.326-4.237,P=0.004)and age≥75 years(OR=1.891,95%CI 1.065-3.358,P=0.030)were independent risk factors for MACE events in patients with non-valvular atrial fibrillation and heart failure.e GFR(OR=0.986,95%IC 0.972-1.000,P=0.046)and use of lipid-lowering drugs(OR=0.380,95%CI 0.212-0.682,P=0.001)were independent protective factors.Multivariate logistic regression analysis was performed with all the variables except the R2CHA2DS2-VASc score from the univariate logistic regression analysis.The results showed that NT-pro BNP>1800 pg/ml(OR=2.790,95%CI 1.584-4.917,P<0.001)and CHA2DS2-VASc score(OR=1.281,95%CI 1.086-1.512,P=0.003)were independent risk factors for MACE events in patients with non-valvular atrial fibrillation and heart failure,and use of lipid-lowering drugs(OR=0.385,95%CI0.215-0.689,P=0.001)was an independent protective factor.Multivariate logistic regression analysis was performed with all the variables except the CHA2DS2-VASc score from the univariate logistic regression analysis.The results showed that NT-pro BNP>1800 pg/ml(OR=2.591,95%CI 1.463-4.588,P=0.001)and R2CHA2DS2-VASc score(OR=1.242,95%CI 1.087-1.419,P=0.001)were independent risk factors for MACE events in patients with non-valvular atrial fibrillation and heart failure,and use of lipid-lowering drugs(OR=0.377,95%CI0.210-0.676,P=0.001)was an independent protective factor.The AUCs of the ROC curves for predicting MACE events in patients with non-valvular atrial fibrillation and heart failure by CHA2DS2-VASc and R2CHA2DS2-VASc scores were 0.601(95%CI,0.532-0.671;P=0.005)and 0.617(95%CI,0.549-0.686;P=0.001),respectively.There was no significant difference between the two areas under the curves(Z=0.883,95%CI-0.0195-0.0515,P=0.377).Conclusion:R2CHA2DS2-VASc score and CHA2DS2-VASc score both have predictive value for MACE events in patients with NVAF and HF. |
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