Changes in the CHADS-VAS score as a predictor of incident atrial fibrillation in older Chinese individuals: the AF-CATCH study.

Aims: Incidence of atrial fibrillation is highly associated with age and cardiovascular co-morbidities. Given this relationship, we hypothesized that the dynamic changes resulting in an increase in the CHADS-VAS score over time would improve the efficiency of predicting incident atrial fibrillation on repeated screening after a negative test.

Methods And Results: We investigated in an analysis of the AF-CATCH trial [quarterly vs. annual electrocardiogram (ECG) screening for atrial fibrillation in older Chinese individuals] data, the association between the changes in the CHADS-VAS score from baseline to end-of-study visit and the risk of incident atrial fibrillation. Participants without a history of atrial fibrillation and with a sinus rhythm at baseline were randomized to the annual (usual) or quarterly 30 s (intensive) single-lead ECG screening groups. During a median follow-up of 2.1 years in 6806 participants, the incidence rate of atrial fibrillation increased from 4.2 per 1000 person-years in participants with a change in the CHADS-VAS score of 0 to 6.4 and 25.8 per 1000 person-years in participants with a change in the CHADS-VAS score of 1 and ≥2, respectively. A change in the CHADS-VAS score of ≥2 was associated with a significantly elevated risk of incident atrial fibrillation.

Conclusions: Patients with substantial changes in the CHADS-VAS score were more likely to develop incident atrial fibrillation, and regular re-assessments of cardiovascular risk factors in the elderly are probably worthwhile to improve the detection of atrial fibrillation.

Registration: URL: http://www.clinicaltrials.gov; Unique identifier: NCT02990741.