The CHA₂DS₂-VASc score has been validated to stratify the risk of thromboembolism and accurately predicts the risk of stroke in patient with non-valvular atrial fibrillation. We sought to investigate how accurately this score predicts the risk of stroke and death in patients with atrial flutter.

Between July 1998 and December 2011, 197 consecutive patients, hospitalised for atrial flutter, were enrolled in the cohort. All patients were followed-up at least 6 months and cardiovascular events recorded. The endpoint was defined as the first occurrence of stroke or death. The Cox analysis was adjusted on warfarin, antiplatelet and antiarrhythmic treatments at discharge.

Mean age was 67±13 years and 152 (77%) were men. At baseline, 92 patients (47%) had hypertension, 33 (17%) diabetes, and 10 (5%) had a history of stroke or thromboembolism. CHA₂DS₂-VASc score was = 0 in 26 (13%), = 1 in 36 (18%), and ≥2 in 135 (69%) patients. Seventy-seven events occurred during a mean follow-up of 4.7±3.7 years. As shown in the Kaplan Meier curves (figure) patients with a CHA₂DS₂-VASc score ≥2 were at higher risk of stroke or death.

The adjusted Cox model showed that a CHA₂DS₂-VASc score ≥2 was a predictor of risk of stroke or death with a hazard ratio of 2.17 (95%CI 1.21-3.90, p=0.009).

These results suggest that a CHA₂DS₂-VASc score ≥2 is associated with a higher risk of stroke and deaths, at mid-term follow-up, in patients with atrial flutter.