Thromboembolic risk stratification of patients hospitalized with heart failure in sinus rhythm: a nationwide cohort study

Aims Patients with heart failure in sinus rhythm are at an increased risk of thromboembolic complications. So far, validated risk stratification tools are lacking for such patients, which makes the decision to initiate anti‐thrombotic treatment difficult. Methods and results We included 136 545 patients admitted with heart failure in sinus rhythm from national registries from 1999 to 2012. Patients receiving oral anticoagulants were omitted from the study. First, we investigated if the CHA 2 DS 2 ‐VASc score could identify heart failure patients in sinus rhythm with high rates of thromboembolic complications. Second, we investigated if any single CHA 2 DS 2 ‐VASc risk factor carried a greater prognostic value with regard to thromboembolism. The risk of thromboembolism increased more than ninefold (hazard ratio 9.2, 95% confidence interval 6.8–12.5) in patients with all CHA 2 DS 2 ‐VASc risk factors compared with those with heart failure alone. The incidence rates of thromboembolism were clinically significant, averaging 6.0 (95% confidence interval 5.98–6.02) events per 100 patient years during the first year following diagnosis. Risk factors such as diabetes, age, vascular disease, and especially previous thromboembolism, conferred an independent risk of future thromboembolism. Conclusion The CHA 2 DS 2 ‐VASc risk stratification scheme was able to provide prognostic information on future thromboembolic events in patients with heart failure in sinus rhythm. The CHA 2 DS 2 ‐VASc scale could be easily implemented as an aid to clinicians in risk stratifying heart failure patients in sinus rhythm, for thromboembolism.