{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T13:44:10Z","timestamp":1776519850345,"version":"3.51.2"},"reference-count":15,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,4,23]],"date-time":"2018-04-23T00:00:00Z","timestamp":1524441600000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Chest\u2010pain patients deemed safe for discharge from internal medicine wards might still be at risk for adverse outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc score improves risk stratification of low\u2010risk chest\u2010pain patients discharged after acute coronary syndrome (ACS) rule\u2010out.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We accessed medical records of patients who were admitted to internal medicine wards at a single medical center during 2010\u20132016 and discharged following an ACS rule\u2010out. Patients were classified according to CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc score: 0\u20131 (low), 2\u20133 (intermediate), &gt;3 (high). Primary endpoint was occurrence of ACS at 1\u2009year; 30\u2010day and 1\u2010year all\u2010cause mortality (ACM) were secondary outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 12\u2009449 patients, 7057 (57%) had low, 3781 (30%) intermediate, and 1611 (13%) high CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc scores. Compared with a low score, intermediate and high scores were associated with significantly increased risk for 1\u2010year ACS during the first year (OR: 2.89, 95% CI: 1.91\u20134.37, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01 and OR: 4.84, 95% CI: 3.02\u20137.74, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01, respectively). Each 1\u2010point increase in CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc was associated with a 37% increased risk for 1\u2010year ACS. A higher CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc score was associated with significantly higher 30\u2010day ACM. Hazard ratios for 30\u2010day ACM were 1.9 (95% CI: 1.1\u20133.4, <jats:italic>P<\/jats:italic>\u2009=\u20090.03) and 4.4 (95% CI: 2.4\u20137.9, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) for intermediate and high CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc scores, respectively, compared with a low score. Each 1\u2010point increase in CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc score was associated with 43% increased risk for 30\u2010day mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>High CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc score (&gt;3) was associated with adverse outcomes among chest\u2010pain patients discharged from internal medicine wards following ACS rule\u2010out.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.22925","type":"journal-article","created":{"date-parts":[[2018,4,24]],"date-time":"2018-04-24T02:29:45Z","timestamp":1524536985000},"page":"539-543","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["CHA<sub>2<\/sub>DS<sub>2<\/sub>\u2010VASc score and clinical outcomes of patients with chest pain discharged from internal medicine wards following acute coronary syndrome rule\u2010out"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5627-9712","authenticated-orcid":false,"given":"Guy","family":"Topaz","sequence":"first","affiliation":[{"name":"Department of Internal Medicine C Meir Medical Center  Kfar Saba Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ory","family":"Haisraely","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine C Meir Medical Center  Kfar Saba Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0805-3185","authenticated-orcid":false,"given":"Yacov","family":"Shacham","sequence":"additional","affiliation":[{"name":"Department of Cardiology Tel Aviv Sourasky Medical Center  Tel Aviv Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gil","family":"Beery","sequence":"additional","affiliation":[{"name":"Department of Cardiology Meir Medical Center  Kfar Saba Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lotan","family":"Shilo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine C Meir Medical Center  Kfar Saba Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuha","family":"Kassem","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine C Meir Medical Center  Kfar Saba Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7989-5817","authenticated-orcid":false,"given":"David","family":"Pereg","sequence":"additional","affiliation":[{"name":"Department of Cardiology Meir Medical Center  Kfar Saba Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yona","family":"Kitay\u2010Cohen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine C Meir Medical Center  Kfar Saba Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,4,23]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"378","article-title":"Chest pain and ischaemic heart disease in primary care","volume":"53","author":"Nilsson S","year":"2003","journal-title":"Br J Gen Pract."},{"key":"e_1_2_6_3_1","doi-asserted-by":"crossref","first-page":"2864","DOI":"10.1001\/jama.285.22.2864","article-title":"Validation of clinical classification schemes of predicting stroke: results from the National Registry of Atrial Fibrillation","volume":"285","author":"Gage BF Waterman AD","year":"2001","journal-title":"JAMA."},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2016.09.010"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.2459\/JCM.0000000000000241"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-016-0877-6"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.07.063"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2013-305303"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0111167"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.11.056"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.01.255"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38985.646481.55"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.7.835"},{"key":"e_1_2_6_14_1","doi-asserted-by":"crossref","first-page":"2557","DOI":"10.1161\/01.CIR.101.22.2557","article-title":"Predictors of outcome in patients with acute coronary syndromes without persistent ST\u2010segment elevation: results from an international trial of 9461 patients","volume":"101","author":"Boersma E","year":"2000","journal-title":"Circulation."},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv320"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2017.01.003"}],"container-title":["Clinical Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fclc.22925","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.22925","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T18:40:47Z","timestamp":1695494447000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/clc.22925"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2018,4]]}},"alternative-id":["10.1002\/clc.22925"],"URL":"https:\/\/doi.org\/10.1002\/clc.22925","archive":["Portico"],"relation":{},"ISSN":["0160-9289","1932-8737"],"issn-type":[{"value":"0160-9289","type":"print"},{"value":"1932-8737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4]]},"assertion":[{"value":"2017-12-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-02-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-04-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}