期刊
EUROPEAN HEART JOURNAL-QUALITY OF CARE AND CLINICAL OUTCOMES
卷 8, 期 2, 页码 214-227出版社
OXFORD UNIV PRESS
DOI: 10.1093/ehjqcco/qcab028
关键词
GARFIELD-AF; CHA(2)DS(2)-VASc; Risk stratification; Atrial fibrillation
资金
- Bayer AG, Berlin, Germany
- KANTOR CHARITABLE FOUNDATION
This study confirms the effectiveness of the GARFIELD-AF integrated risk tool in predicting mortality, stroke, and bleeding in patients with atrial fibrillation, and compares it with the traditional predictors CHA(2)DS(2)-VASc and HAS-BLED.
Aims To determine whether the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) integrated risk tool predicts mortality, non-haemorrhagic stroke/systemic embolism, and major bleeding for up to 2 years after new-onset AF and to assess how this risk tool performs compared with CHA(2)DS(2)-VASc and HAS-BLED. Methods and results Potential predictors of events included demographic and clinical characteristics, choice of treatment, and lifestyle factors. A Cox proportional hazards model was identified for each outcome by least absolute shrinkage and selection operator methods. Indices were evaluated in comparison with CHA(2)DS(2)-VASc and HAS-BLED risk predictors. Models were validated internally and externally in ORBIT-AF and Danish nationwide registries. Among the 52 080 patients enrolled in GARFIELD-AF, 52 032 had follow-up data. The GARFIELD-AF risk tool outperformed CHA(2)DS(2)-VASc for all-cause mortality in all cohorts. The GARFIELD-AF risk score was superior to CHA(2)DS(2)-VASc for non-haemorrhagic stroke, and it outperformed HAS-BLED for major bleeding in internal validation and in the Danish AF cohort. In very low- to low-risk patients [CHA(2)DS(2)-VASc 0 or 1 (men) and 1 or 2 (women)], the GARFIELD-AF risk score offered strong discriminatory value for all the endpoints when compared to CHA(2)DS(2)-VASc and HAS-BLED. The GARFIELD-AF tool also included the effect of oral anticoagulation (OAC) therapy, thus allowing clinicians to compare the expected outcome of different anticoagulant treatment decisions [i.e. no OAC, non-vitamin K antagonist (VKA) oral anticoagulants, or VKAs]. Conclusions The GARFIELD-AF risk tool outperformed CHA(2)DS(2)-VASc at predicting death and non-haemorrhagic stroke, and it outperformed HAS-BLED for major bleeding in overall as well as in very low- to low-risk group patients with AF.
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