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All Journal Indonesian Journal of Cardiology
Putra, Iwan Cahyo Santosa
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Health Professions Medicine & Pharmacology

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Usefulness of The CHADS2 and CHA2DS2-VASc Scores in Predicting In-Hospital Mortality in Acute Coronary Syndrome Patients: A Single-Center Retrospective Cohort Study Pramudyo, Miftah; Putra, Iwan Cahyo Santosa; Pratama, Fahmi Bagus; Pranata, Raymond
Jurnal Kardiologi Indonesia Vol 44 No 1 (2023): Indonesian Journal of Cardiology: January - March 2023
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1294

Abstract

BackgroundAlthough the GRACE risk score is widely accepted as an established scoring system to predict in-hospital mortality in acute coronary syndrome (ACS) patients, this scoring system still depends on electrocardiography and laboratory findings to determine the results. Therefore, we aim to retrospectively evaluate the association between the CHADS2 and CHA2DS2-VASc score as an anamnesis-only mediated scoring system and in-hospital mortality in hospitalized ACS patients. MethodsThis retrospective cohort study analyzed data of ACS patients from the ACS registry in Dr. Hasan Sadikin Central General Hospital from 2018 to 2021. The outcome of this study was in-hospital mortality. The association between these scoring system and in-hospital mortality were evaluated using binary logistic regression analysis. Receiver operating characteristics (ROC) analysis was also performed to assess the success rate of this scoring system in predicting in-hospital mortality. ResultsA total of 1339 patients were included in this study, and 162 (12.1%) of them died in the hospital. High CHA2DS2-VASc score group (cut-off >2) was significantly associated with higher risk of in-hospital mortality before (OR=2.56 [1.75,3.75]; p<0.001) and after adjustment of several confounding factors (OR=3.39 [1.73,6.64]; p<0.001). Meanwhile, the high CHADS2 score (cutoff >2) was only significantly increased the risk of in-hospital mortality in univariate analysis (OR=2.05[1.47,2.87];p<0.001), but was not significantly associated with in-hospital mortality after multivariate analysis (OR=1.31 [0.92,1.86];p=0.129). ROC analysis revealed that predictive accuracy of CHA2DS2-VASc score was significantly greater compared to CHADS2 score (AUC: 0.653 vs 0.609, p<0.001). However, the predictive value of CHA2DS2-VASc score was significantly lower than the GRACE risk score (AUC: 0.789 vs 0.653, p<0.001). ConclusionOur study showed that the CHA2DS2-VASc score >2 was significantly and independently associated with higher in-hospital mortality in ACS patients compared to the CHA2DS2-VASc score of 1 or lower. Despite its lower predictive accuracy compared to the GRACE risk score, CHA2DS2-VASc score can still be used in practical situations as an alternative scoring system in predicting in-hospital mortality in ACS patients, especially in primary health care settings located in rural areas that lack the diagnostic facilities.This article has a related Erratum.
Management of Decongestion in Acute Heart Failure: Time for a New Approach? Pramudyo, Miftah; Putra, Iwan Cahyo Santosa; Zulkarnain, Edrian; Danny, Siska Suridanda; Bagaswoto, Hendry Purnasidha; Anjarwani, Setyasih; Mazwar, Irmaliyas; Juzar, Dafsah Arifa; Pratama, Vireza; Habib, Faisal; Ispar, Akhtar Fajar Muzakkir Ali; Widyantoro, Bambang
Jurnal Kardiologi Indonesia Vol 43 No 2 (2022): Indonesian Journal of Cardiology: April - June 2022
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1381

Abstract

As the primary cause of hospitalization in acute heart failure (AHF) patients, congestion was responsible for a higher risk of mortality, rehospitalization, and renal dysfunction in AHF patients. Although loop diuretic was routinely used as the mainstay of AHF therapy, it is still ineffective to obtain the euvolemic state in most hospitalized AHF patients. Therefore, a higher loop diuretic dose was often required to increase the decongestion effect. However, consequently, it can cause several detrimental complications, including renal dysfunction, neurohormonal activation, hyponatremia, hypokalaemia, and reduced blood pressure, which eventually result in poor prognosis. Hence, the new approach may be proposed to optimize decongestion in acute phase, including the use of arginine vasopressin V2 receptor antagonist – Tolvaptan. As an additive therapy to loop diuretic in AHF patients, it can be considered due to its several beneficial effects, including greater decongestion effect, lowered worsening renal function incidence, counteract neurohormonal activation, neutralized hyponatraemic state, no alteration of potassium metabolism, stabilize the blood pressure, and reduced requirement of a higher dose of loop diuretic to achieve an equal or even greater decongestion effect compared to a high dose of loop diuretic alone. Tolvaptan provided favourable outcomes in several specific populations and was considered safe with several mild adverse effects. Several guidelines across countries have approved the use of Tolvaptan in AHF patients with or without hyponatremia. The initial dose of Tolvaptan was 7.5 to 15 mg and can be titrated up to 30 mg. However, further studies were still required to determine the timing dose and optimal dose of Tolvaptan in general and elderly populations with AHF, respectively.This article has a related Erratum.
Usefulness of The CHADS2 and CHA2DS2-VASc Scores in Predicting In-Hospital Mortality in Acute Coronary Syndrome Patients: A Single-Center Retrospective Cohort Study Pramudyo, Miftah; Putra, Iwan Cahyo Santosa; Pratama, Fahmi Bagus; Pranata, Raymond
Jurnal Kardiologi Indonesia Vol 46 No 4 (2025): October - December, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2013

Abstract

In “Usefulness of The CHADS2 and CHA2DS2-VASc Scores in Predicting In-Hospital Mortality in Acute Coronary Syndrome Patients: A Single-Center Retrospective Cohort Study” (Indonesian Journal of Cardiology, 44(1), 17-27. https://doi.org/10.30701/ijc.1294), there is an error noted. An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1294. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.The publisher apologizes for any inconvenience caused by this error. DOI of original article: https://doi.org/10.30701/ijc.1294
Management of Decongestion in Acute Heart Failure: Time for a New Approach? Pramudyo, Miftah; Putra, Iwan Cahyo Santosa; Zulkarnain, Edrian; Danny, Siska Suridanda; Danny, Hendry Purnasidha; Anjarwani, Setyasih; Mazwar, Irmaliyas; Juzar, Dafsah Arifa; Pratama, Vireza; Habib, Faisal; Ispar, Akhtar Fajar Muzakkir Ali; Widyantoro, Bambang
Jurnal Kardiologi Indonesia Vol 46 No 4 (2025): October - December, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2036

Abstract

In “Management of Decongestion in Acute Heart Failure: Time for a New Approach?” (Indonesian Journal of Cardiology, 43(2), 77-89. https://doi.org/10.30701/ijc.1381), there is an error noted. An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1381. The error occurs only in the PDF; the DOI listed in the article metadata is already correct. The publisher apologizes for any inconvenience caused by this error.DOI of original article: https://doi.org/10.30701/ijc.1381
Co-Authors Anjarwani, Setyasih Bambang Widyantoro Danny, Hendry Purnasidha Habib, Faisal Hendry Purnasidha Bagaswoto Ispar, Akhtar Fajar Muzakkir Ali Juzar, Dafsah Arifa Mazwar, Irmaliyas Pramudyo, Miftah Pranata, Raymond Pratama, Fahmi Bagus Pratama, Vireza Siska Suridanda Danny Zulkarnain, Edrian