CHA₂DS₂-VASc Score and Adverse Cardiovasculare Outcomes of Patients on Hemodialysis

Background: Despite their very high cardiovascular risk, patients on chronic hemodialysis have traditionally been under-represented in most large cardiovascular studies. The current study was aimed to assess whether the CHA₂ DS₂ -VASc score may be used for the assessment of mortality and cardiovascular risk in this high risk population.

Methods: Included in the study were patients undergoing chronic hemodialysis at the Meir Medical Center. The CHA2DS2-VASc Score was calculated for each patient according to baseline characteristics at the initiation of hemodialysis. Patients were classified according to CHA₂ DS₂ -VASc score: 0-3 (low), 4-5 (intermediate), >5 (high). Primary endpoint was the composite of all-cause mortality, myocardial infarction and stroke during the first year of hemodialysis.

Results: Of 457 patients, 181 (40%) had low, 193 (42%) intermediate, and 83(18%) high CHA₂ DS₂ -VASc scores. Compared with a low score, intermediate and high scores were associated with significantly increased risk for 1-year composite of all-cause mortality, myocardial infarction and stroke (OR: 2.6, 95% CI: 1.6-4.2, p < 0.01 and OR: 4.2, 95% CI: 2.3-7.5, P < 0.01, respectively). Each 1-point increase in CHA₂ DS₂ -VASc was associated with a 38% increased risk for the composite endpoint. For the secondary endpoints, each 1-point increase in CHA₂ DS₂ -VASc was associated with a 19% and 29% increased risk for 1-year myocardial infarction and stroke, respectively.

Conclusions: High CHA₂ DS₂ -VASc score was associated with a significant increase in mortality and adverse cardiovascular outcomes during the first year of hemodialysis.