Clinical Outcomes, Management, Healthcare Resource Utilization, and Cost According to the CHA2DS2-VASc Scores in Asian Patients with Nonvalvular Atrial Fibrillation
Authors: Fan Keye , Xiao Yue , Xue Aoming , Zhou Jifang 
Published: April 2024

Background

The prognosis among non-valvular atrial fibrillation (NVAF) patients with different CHA2DS2-VASc scores in the contemporary Asian population remains unclear. Additionally, there is a lack of research examining the disparities in management patterns, healthcare resource utilization (HCRU), and cost among these patients. Therefore, this study aims to assess the incidence of clinical outcomes in NVAF patients with different CHA2DS2-VASc scores and explore their management patterns, HCRU, and cost.

Methods and Results

This retrospective cohort study assessed patients diagnosed with NVAF between January 2018 and July 2022, utilizing a merged dataset from China. Patients were stratified into 3 cohorts by CHA2DS2-VASc scores: low-risk (0 for males, 1 for females), intermediate-risk (1 for males, 2 for females), and high-risk (≥2 for males, ≥3 for females). One-year incidence rates of clinical outcomes (including ischemic stroke, transient ischemic attack, arterial embolism, and major bleeding) were calculated as events per 100 person-years. Cumulative incidence and crude and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were calculated using the Fine and Gray models. Management patterns, HCRU, and cost were analyzed descriptively. Among 419,490 NVAF patients (mean age: 75.2 years, 45.1% female), 16,541 (3.9%) were classified as low-risk, 38,494 (9.2%) as intermediate-risk, and 364,455 (86.9%) as high-risk. The mean (SD) age-adjusted Charlson comorbidity index score was 4.7 (2.0), increasing with CHA2DS2-VASc scores. The one-year cumulative incidence of ischemic stroke was 3.2% (95% CI, 2.9%–3.5%) for low-risk, 4.9% (95% CI, 4.7%–5.2%) for intermediate-risk (aHR, 1.3, 95% CI, 1.2–1.4), and 12.2% (95% CI, 12.1%–12.3%) for high-risk (aHR, 2.5, 95% CI, 2.3–2.8). Meanwhile, the incidence of transient ischemic attack, arterial embolism, and major bleeding showed a similar increasing trend from low-risk to high-risk. Within one year after the index date, 16.4% of patients in the low-risk cohort received oral anticoagulants (OACs), while 11.1% of patients in the high-risk cohort received OACs. The mean (SD) number of all-cause hospitalizations was 0.1 (0.1), 0.1 (0.2), and 0.1 (0.3) per-patient-per-month (PPPM) for low-risk, intermediate-risk, and high-risk, respectively. The mean (SD) length of stay increased from 0.9 (1.1) days PPPM for the low-risk to 1.2 (1.8) days PPPM for the high-risk.

Conclusion

This study demonstrates that contemporary Asian NVAF patients with higher CHA2DS2-VASc scores experience higher incidence of adverse outcomes and increased hospital resource consumption. There is insufficient utilization of OACs and other AF management measures across all CHA2DS2-VASc scores groups. These findings provide new evidence for improving patient management and guiding resource allocation in healthcare.

Clinical Perspective

What Is New?

This large-scale study assessed the incidence of adverse clinical outcomes among contemporary Asian atrial fibrillation patients by CHA2DS2-VASc scores.

This study demonstrated suboptimal management across all CHA2DS2-VASc score groups, with higher hospital resource utilization observed in groups with higher CHA2DS2-VASc scores.

What Are the Clinical Implications?

This study indicated that AF patients with elevated CHA2DS2-VASc scores face a greater risk of adverse clinical outcomes.

Our findings informed decision-making on healthcare resource allocation and AF management.