scholarly journals Stroke risk scores to predict hospitalization for acute decompensated heart failure in atrial fibrillation patients

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Andreea Cristina Ivănescu ◽  
Gheorghe-Andrei Dan
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Predictive Accuracy ◽  
Acute Decompensated Heart Failure ◽  
University Hospital ◽  
Risk Scores ◽  
P Value ◽  
Risk Of Death ◽  
Increased Risk

AbstractIntroduction: Atrial fibrillation (AF) is the most frequent hospitalized arrhythmia. It associates increased risk of death, stroke and heart failure (HF). Stroke risk scores, especially CHA2DS2-VASc, have been applied also for populations with different diseases. There is, however, limited data focusing on the ability of these scores to predict HF decompensation.Methods: We conducted a retrospective observational study on a cohort of 204 patients admitted for cardiovascular pathology to the Cardiology Ward of our tertiary University Hospital. We aimed to determine whether the stroke risk scores could predict hospitalisations for acute decompensated HF in AF patients.Results: C-statistics for CHADS2 and R2CHADS2 showed a modest predictive ability for hospitalisation with decompensated HF (CHADS2: AUC 0.631 p=0.003; 95%CI 0.560-0.697. R2CHADS2: AUC 0.619; 95%CI 0.548-0.686; p=0.004), a marginal correlation for CHA2DS2-VASc (AUC 0.572 95%CI 0.501-0.641 with a p value of only 0.09, while the other scores failed to show a correlation. A CHADS2≥2 showed a RR=2.96, p<0.0001 for decompensated HF compared to a score <2. For R2CHADS2 ≥2, RR= 2.41, p=0.001 compared to a score <2. For CHA2DS2-VASc≥2 RR=2.18 p=0.1, compared to CHA2DS2-VASc <2. The correlation coefficients showed a weak correlation for CHADS2 (r=0.216; p=0.001) and even weaker for R2CHADS2 (r=0.197; p=0.0047 and CHA2DS2-VASc (r=0.14; p=0.035).Conclusions: Among AF patients, CHADS2, CHA2DS2-VASc and R2CHADS2 were associated with the risk of hospitalisation for decompensated HF while ABC and ATRIA failed to show an association. However, predictive accuracy was modest and the clinical utility for this outcome remains to be determined.

scholarly journals Performance of Atrial Fibrillation Risk Prediction Models in Over Four Million Individuals

2020 ◽  
Author(s):  
Shaan Khurshid ◽  
Uri Kartoun ◽  
Jeffrey M. Ashburner ◽  
Ludovic Trinquart ◽  
Anthony Philippakis ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Risk Prediction ◽  
Proportional Hazards ◽  
Prediction Models ◽  
Predictive Accuracy ◽  
Health Management ◽  
Cox Proportional Hazards ◽  
Risk Scores ◽  
Office Visits

Background - Atrial fibrillation (AF) is associated with increased risks of stroke and heart failure. Electronic health record (EHR) based AF risk prediction may facilitate efficient deployment of interventions to diagnose or prevent AF altogether. Methods - We externally validated an EHR atrial fibrillation (EHR-AF) score in IBM Explorys Life Sciences, a multi-institutional dataset containing statistically de-identified EHR data for over 21 million individuals ("Explorys Dataset"). We included individuals with complete AF risk data, ≥2 office visits within two years, and no prevalent AF. We compared EHR-AF to existing scores including CHARGE-AF, C 2 HEST, and CHA 2 DS 2 -VASc. We assessed association between AF risk scores and 5-year incident AF, stroke, and heart failure using Cox proportional hazards modeling, 5-year AF discrimination using c-indices, and calibration of predicted AF risk to observed AF incidence. Results - Of 21,825,853 individuals in the Explorys Dataset, 4,508,180 comprised the analysis (age 62.5, 56.3% female). AF risk scores were strongly associated with 5-year incident AF (hazard ratio [HR] per standard deviation [SD] increase 1.85 using CHA 2 DS 2 -VASc to 2.88 using EHR-AF), stroke (1.61 using C 2 HEST to 1.92 using CHARGE-AF), and heart failure (1.91 using CHA 2 DS 2 -VASc to 2.58 using EHR-AF). EHR-AF (c-index 0.808 [95%CI 0.807-0.809]) demonstrated favorable AF discrimination compared to CHARGE-AF (0.806 [0.805-0.807]), C 2 HEST (0.683 [0.682-0.684]), and CHA 2 DS 2 -VASc (0.720 [0.719-0.722]). Of the scores, EHR-AF demonstrated the best calibration to incident AF (calibration slope 1.002 [0.997-1.007]). In subgroup analyses, AF discrimination using EHR-AF was lower in individuals with stroke (c-index 0.696 [0.692-0.700]) and heart failure (0.621 [0.617-0.625]). Conclusions - EHR-AF demonstrates predictive accuracy for incident AF using readily ascertained EHR data. AF risk is associated with incident stroke and heart failure. Use of such risk scores may facilitate decision-support and population health management efforts focused on minimizing AF-related morbidity.

Abstract 17226: Increased Risk of Heart Failure Associated With Left Atrial Remodeling Without Known Atrial Fibrillation

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Jodi Edwards ◽  
Jiming Fang ◽  
Jeff S Healey ◽  
Kathy Yip ◽  
Lisa Mielniczuk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Ventricular ◽  
Administrative Databases ◽  
Risk Scores ◽  
Atrial Remodeling ◽  
Left Atrial Remodeling ◽  
Lv Dysfunction ◽  
Increased Risk

Background: Atrial fibrillation (AF) significantly increases risk for heart failure (HF) and independently increases mortality and adverse in-hospital outcomes in HF patients. Validated clinical risk scores (ARC2H) can predict HF in patients with AF, but are limited in application as AF is frequently clinically silent or undetected. However, AF may be preceded by significant preclinical remodeling (left atrial enlargement (LAE) or excessive atrial ectopy (EAE)). Whether LAE and EAE are associated with HF prior to AF is unclear. Method(s): We analyzed consecutive adults >65 years with outpatient echocardiography or Holter at 11 Ontario community cardiology clinics (2010-2017). Exclusions were history of AF, anticoagulation, pacemaker/ICD/ILR, and prosthetic valve. Using linked administrative databases, we assessed 5-year rates of HF (primary) and incident AF and death (secondary) associated with LAE and EAE and among subgroups (M vs. F; <75 vs. >75; CHADS-VASC 0-2 vs. 3-6). Competing risks cox proportional hazards estimated adjusted hazard of HF for severe LAE: >47mm (M);>52mm (F)) or increased APBs/hour (EAE: >30) or both LAE and EAE, adjusting for age, vascular comorbidities and left ventricular (LV) dysfunction. Results: In 28,261 adults (mean 73+/-6 years), direct age-adjusted survival was reduced for those with severe LAE and EAE. 5-year rates of HF were increased for severe (8.8%) vs. moderate (3.5%) and mild (1.4%) LAE and for those with excessive (3.8%) vs. normal (2.5%) ectopy. For both LAE and EAE, those >75 and with a CHADS score 3-6 showed marked increases in HF at 5 years compared to <75 (LAE: 10.6% vs. 7.9%; EAE: 4.3% vs. 1.9%) and CHADS score 0-2 (LAE:21.4% vs. 6.6%; EAE: 8.9% vs. 2.4%). Severe LAE increased hazard of HF 2-fold (HR=2.07; p<.0001), and incident AF over 3-fold (HR= 3.43; p<.0001) and EAE increased hazard of HF (HR=1.31; p<.0001) and incident AF (HR=1.13; p<.0001). Those with both LAE and EAE showed an over 3-fold increased hazard of HF (HR=3.28; p<.0014). Conclusions: Severe LAE and EAE without known AF are associated with increased risk of HF and AF after adjusting for LV dysfunction, particularly for those >75 and with high vascular burden. These data have implications for risk stratification, AF screening, and trials for HF prevention in individuals with left atrial remodeling.

Abstract 12936: Impact of Mitral Regurgitation on Heart Failure Hospitalization and Mortality in Older Age Adults With a Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ginger Y Jiang ◽  
Warren J Manning ◽  
Lawrence Markson ◽  
A. R Garan ◽  
Marwa A Sabe ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
P Value ◽  
Preserved Ejection Fraction ◽  
Risk Of Death ◽  
Increased Risk ◽  
All Cause Mortality

Background: The effect of mitral regurgitation (MR) severity on heart failure (HF) hospitalization and mortality in individuals with a preserved ejection fraction (LVEF) and no prior HF history is uncertain. Methods: Transthoracic echocardiogram (TTE) reports from patients with an LVEF > 50% at our institution were linked to complete Medicare inpatient claims, 2003-2017. Patients with HF hospitalization within the 12 months prior to TTE were excluded. We evaluated the relationship of baseline MR severity and time to the composite of all-cause mortality or HF hospitalization using the Kaplan-Meier technique. Secondary outcomes included the individual components of all-cause mortality and HF hospitalization, adjusting for the competing risk of death with Fine-Gray methods. Results: A total of 18,315 individuals met inclusion criteria (77.6 ±7.7 years, 54.3% female). Over a median follow-up time of 6.5 (IQR 3.0 to 10.2) years, the primary endpoint occurred in 7566 individuals (50.6%) of whom 6,927 (37.8%) died and 1703 (13.9%) were admitted for HF at a median of 1.4 (IQR 0.2 to 4.3) years and 1.6 (IQR 0.2 to 4.3) years respectively ( Figure ). After multivariable adjustment, MR severity was not associated with the primary or secondary outcome at 1-, 3-, 5-, or 10-years after TTE (p > 0.05 for all). Mitral valve prolapse (MVP) was associated with decreased risk of the primary outcome at 1-year and 3-years (interaction p-value = 0.04 for both). Jet eccentricity did not impact the observed relationship (interaction p-value > 0.05). Conclusions: In this large, single institution echocardiographic study of individuals with preserved ejection fraction and no prior history of HF, MR severity was not associated with an increased risk of all-cause mortality or HF hospitalization. Presence of MVP was associated with decreased risk of the primary outcome with increasing MR severity.

scholarly journals ATRIAL FIBRILLATION IN HEART FAILURE IS ASSOCIATED WITH AN INCREASED RISK OF DEATH ONLY IN PATIENTS WITH ISCHEMIC HEART DISEASE

2010 ◽  
Vol 55 (10) ◽  
pp. A28.E269
Author(s):  
Jakob Raunso ◽  
Ole D. Pedersen ◽  
Helena Dominguez ◽  
Morten L. Hansen ◽  
Jacob E. Moller ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Ischemic Heart ◽  
Risk Of Death ◽  
Increased Risk

The CHADS2 score predicts ischemic stroke in chronic heart failure patients without atrial fibrillation: comparison to other stroke risk scores

2016 ◽  
Vol 32 (2) ◽  
pp. 193-200 ◽  
Author(s):  
Takumi Kondo ◽  
Takahisa Yamada ◽  
Takashi Morita ◽  
Yoshio Furukawa ◽  
Shunsuke Tamaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Chronic Heart Failure ◽  
Stroke Risk ◽  
Risk Scores ◽  
Chads2 Score ◽  
Heart Failure Patients

scholarly journals Prognostic significance of polyvascular disease in patients admitted with acute decompensated heart failure: the ARIC Study Community Surveillance

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Z Chunawala ◽  
A Qamar ◽  
S Arora ◽  
A Pandey ◽  
M Fudim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Prognostic Significance ◽  
Decompensated Heart Failure ◽  
Arterial Disease ◽  
Public Institution ◽  
Risk Of Death ◽  
Increased Risk ◽  
Medical Histories ◽  
Aric Study

Abstract Introduction The prevalence and outcomes of polyvascular disease (PVD) in patients admitted with acute decompensated heart failure (ADHF) have not been previously reported, nor is it known whether associations differ for heart failure (HF) with reduced vs. preserved ejection fraction (HFrEF vs HFpEF, respectively). Purpose To investigate the relationship between atherosclerotic involvement of multiple arterial territories and mortality in patients hospitalized with ADHF. Methods The Atherosclerosis Risk in Communities (ARIC) study conducted hospital surveillance of adjudicated heart failure in 4 US areas from 2005–2014, with events verified by physician review. Medical histories were abstracted from the hospital record. PVD was defined by coexisting disease in ≥2 arterial beds, identified by prevalent coronary artery disease, peripheral arterial disease, and cerebrovascular disease. Mortality hazards of PVD vs. no PVD were analyzed separately for HFpEF and HFrEF, with adjustment for age, race, sex, year of admission and geographic region. All analyses were weighted by the inverse of the sampling probability. Results Of 24,936 ADHF hospitalizations (52% female, 32% Black, mean age 75 years), 19% had PVD (22% among HFrEF hospitalizations, 17% among HFpEF hospitalizations), Figure 1. There was an increasing trend in 1-year mortality with 0, 1 and ≥2 arterial bed involvement, both for patients with HFrEF (29% to 32% to 38%; P-trend=0.0006) and HFpEF (26% to 32% to 37%; P-trend &lt;0.0001). After adjustments, PVD was associated with a 20% higher hazard of 1-year mortality in patients with HFrEF (HR=1.23; 95% CI: 1.06–1.44) and a 30% higher hazard in patients with HFpEF (HR=1.33; 95% CI: 1.09–1.63), with no significant interaction by HF type (P-interaction = 0.5). Conclusion Patients hospitalized with ADHF and coexisting PVD have an increased risk of death, irrespective of HF type. Clinical attention should be directed toward PVD, with secondary prevention strategies enacted to improve the prognosis of this vulnerable population. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Institutes of Health Distributions of arterial disease Trends in 1-year mortality outcomes

Incidence, type and prediction of death in anticoagulated patients with atrial fibrillation: a post-hoc analysis from the SPORTIF trials

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Proietti ◽  
J.M River-Caravaca ◽  
D Pastori ◽  
G.Y.H Lip
Keyword(s):  
Atrial Fibrillation ◽  
Cumulative Incidence ◽  
Predictive Ability ◽  
Risk Scores ◽  
Predictive Capacity ◽  
Risk Of Death ◽  
Increased Risk ◽  
Comorbidity Index ◽  
Post Hoc ◽  
Anticoagulated Patients

Abstract Introduction Patients with atrial fibrillation (AF) are at substantially increased risk of death. Uncertainty still remains about the best risk tool to to stratify and predict mortality risk. Aim To report the incidence of death according to cause in anticoagulated AF patients. Second, to evaluate the predictive ability of several risk scores. Methods Patients from the warfarin arms of the SPORTIF trials were considered for analysis. All-cause death, cardiovascular (CV) death and non-CV death were study outcomes. The 2MACE score, crude number of diseases (CND), charlson comorbidity index (CCI) and GARFIELD-AF Death score were predictive tools. Results 3665 patients (mean [SD] age 70.9 [8.9] years. 69.5% males; median [IQR] CHA2DS2-VASc 3 [2–4]) were analysed. Median [IQR] scores were: 2MACE 2 [1–3]; CND 5 [3–7]; CCI 2 [1–3]. Throughout a median [IQR] of 567 [491–652] days there were 204 (5.6%) all-cause deaths, 134 (3.7%) CV deaths and 70 (1.9%) non-CV deaths. The incidence of all-cause death was 3.59 per 100 patient-years, and for CV death and non-CV death, 2.39 per 100 patient-years and 1.23 per 100 patient-years, respectively. Cumulative incidence of all cause, CV and non-CV deaths is are shown in the Figure. After multivariable adjustment, all the tools were found associated with an increased risk of all-cause death (2MACE HR: 1.28, 95% CI: 1.17–1.40; CND HR: 1.07, 95% CI: 1.04–1.11; CCI HR: 1.33, 95% CI: 1.22–1.44; GARFIELD-AF Death HR: 1.85, 95% CI: 1.52–2.26 per each 0.100 increase). Similar results were found for CV death and non-CV death. All risk tools were only modestly predictive of the three outcomes (c-indexes &lt;0.7; Table). In predicting all-cause death, CCI and GARFIELD-AF Death were similarly predictive with small differences compared to other tools; conversely 2MACE and GARFIELD-AF Death showed similar predictive capacity for CV death, while CND and CCI had a slightly better predictivity for non-CV death. Conclusions AF patients have a high mortality, particularly for CV death. All risk scores are associated with occurrence of all-cause mortality, having a similar (but modest) predictive capacity. GARFIELD-AF Death and the simpler 2MACE had the highest predictive value for CV death, while multimorbidity tools (CND and CCI) were more predictive for Non-CV death. Cumulative Incidence of Death Events Funding Acknowledgement Type of funding source: None

Abstract P115: Atrial Fibrillation And The Risk Of Subsequent Fracture

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Jason Sherer ◽  
Qiuxi Huang ◽  
Douglas Kiel ◽  
Emelia J Benjamin ◽  
Ludovic Trinquart
Keyword(s):  
Atrial Fibrillation ◽  
Framingham Heart Study ◽  
P Value ◽  
Primary Analysis ◽  
Risk Of Death ◽  
Hazard Ratios ◽  
Conflicting Evidence ◽  
Heart Study ◽  
Increased Risk ◽  
Subsequent Fracture

Background: There is conflicting evidence regarding the association between atrial fibrillation (AF) and the risk of subsequent fractures. Methods: We included participants aged 45 years or older from the Framingham Heart Study Offspring, Third Generation, New Offspring Spouse, Omni 1, and Omni 2 cohorts. We prespecified analyzing index age 65 years as our primary analysis; we repeated analyses for index age 45, 55, and 75 years. The primary outcome was any bone fracture, except finger, toe, foot, skull, and facial fractures. We assessed the association between time-varying AF and subsequent fractures by an illness-death model that accounted for the competing risk of death. We estimated hazard ratios (HR) adjusted for age, sex, body mass index, smoking, diabetes, alcohol intake, and prior fracture. Results: We included 3,403 participants (mean age of 68 years, 53.3% female) in the analysis at index age 65 years and above. In all, 525 (15%) participants developed incident fractures during follow-up. The HR between AF and subsequent fracture was 1.36 95%CI (1.05-1.77). There was no evidence of effect modification by sex (HR 1.63, 95%CI 1.05-2.23 in men; HR 1.22, 95%CI 0.84-1.76; interaction p value 0.27). Results were consistent at other index ages. Conclusion: AF was associated with increased risk of incident fracture in the community-based Framingham Heart Study.

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