CHA2DS2-VASc Score in Patients With Atrial Fibrillation and Cancer: A U.S. Nationwide Study.

The CHA2DS2-VASc score is widely accepted as the most reliable tool for risk stratification to guide the initiation of anticoagulation in patients with atrial fibrillation/flutter. However, it has not been validated for use in patients with malignancy, and lacks cancer-related parameters. We aimed to evaluate the CHA₂DS₂-VASc score's association with acute cerebrovascular accident (CVA) in cancer patients during hospitalization for atrial fibrillation/flutter in the United States. We conducted a cross-sectional analysis of the Nationwide Readmissions Database (NRD) from 2016 to 2019, extracting all cases with a primary diagnosis of atrial fibrillation/flutter. We then divided all patients based on the presence or absence of malignancy and calculated CHA₂DS₂-VASc scores. We identified 1,769,603 weighted admissions with atrial fibrillation/flutter, of those, 96,982 had malignancy. The cohort with malignancy had a mean age of 74 years (SD, 13.4) vs 70.4 years (SD, 17.8). In both cohorts, each additional point in the CHA₂DS₂-VASc score was associated with higher odds of acute CVA during index hospitalization. For the cohort with malignancy, a score of 2 (compared to 0) was associated with an odds ratio (OR) of 4.73 (1.71 to 13.10) compared with 2.61 (2.08 to 3.27) for the cohort without malignancy. In conclusion, the CHA₂DS₂-VASc score was linearly associated with acute CVA in patients with atrial fibrillation/flutter with and without cancer. However, the odds ratios were higher in the cohort with malignancy, emphasizing the importance of anticoagulation initiation in patients with cancer.