CHA2DS2-VA Score for Predicting Ventricular Arrhythmias and Mortality in ICD Patients with Ischemic Heart Disease and Dilated Cardiomyopathy: Results from a Prospective Cohort

Background and aimsThe revised CHA2DS2-VA score facilitates stroke risk assessment in patients with atrial fibrillation. This study investigates the value of the CHA2DS2-VA for prediction of all-cause and cardiovascular mortality and ventricular arrhythmia (VA) in patients with ischemic heart disease (IHD) and dilated cardiomyopathy (DCM) undergoing implantable cardioverter-defibrillator (ICD) therapy.MethodsWe analyzed data from 1,626 ICD recipients with IHD (n = 1,225) or DCM (n = 401) enrolled in a prospective registry at University Hospital Basel. Patients were stratified into low and high CHA2DS2-VA groups based on median score within each condition. Mortality and VA outcomes were assessed using Kaplan–Meier survival analysis and Cox proportional hazards models.ResultsThe median CHA2DS2-VA was 3 overall, 2 in DCM, and 4 in IHD patients. During a median follow-up of 7.5 years, 46% died, with an all-cause mortality rate of 6.1 per 100 patient-years. Higher CHA2DS2-VA scores were associated with increased all-cause and cardiovascular mortality in both IHD (HR 2.36, 95% CI 1.99–2.80, p < 0.001 for all-cause death) and DCM (HR 1.98, 95% CI 1.44–2.73, p < 0.001 for all-cause death). Each one-point increase in CHA2DS2-VA increased mortality risk (HR 1.4, 95% CI 1.34–1.47, p < 0.001 for all-cause death). No association was observed between CHA2DS2-VA and VA occurrence in the overall cohort or subgroups.ConclusionThe CHA2DS2-VA is strongly associated with all-cause and cardiovascular mortality in ICD patients with IHD and DCM, but does not predict VA. Thus, it may aid in mortality risk stratification but should not be used as a primary tool for arrhythmic risk assessment.