Association between clinical risk scores and mortality in atrial fibrillation: Systematic review and network meta-regression of 669,000 patients

Abstract

Aims Many clinical scores for risk stratification in patients with atrial fibrillation have been proposed, and some have been useful in predicting all-cause mortality. We aim to analyse the relationship between clinical risk score and all-cause death occurrence in atrial fibrillation patients. Methods We performed a systematic search in PubMed and Scopus from inception to 22 July 2017. We considered the following scores: ATRIA-Stroke, ATRIA-Bleeding, CHADS2, CHA2DS2-VASc, HAS-BLED, HATCH and ORBIT. Papers reporting data about scores and all-cause death rates were considered. Results Fifty studies and 71 scores groups were included in the analysis, with 669,217 patients. Data on ATRIA-Bleeding, CHADS2, CHA2DS2-VASc and HAS-BLED were available. All the scores were significantly associated with an increased risk for all-cause death. All the scores showed modest predictive ability at five years (c-indexes (95% confidence interval) CHADS2: 0.64 (0.63–0.65), CHA2DS2-VASc: 0.62 (0.61–0.64), HAS-BLED: 0.62 (0.58–0.66)). Network meta-regression found no significant differences in predictive ability. CHA2DS2-VASc score had consistently high negative predictive value (≥94%) at one, three and five years of follow-up; conversely it showed the highest probability of being the best performing score (63% at one year, 60% at three years, 68% at five years). Conclusion In atrial fibrillation patients, contemporary clinical risk scores are associated with an increased risk of all-cause death. Use of these scores for death prediction in atrial fibrillation patients could be considered as part of holistic clinical assessment. The CHA2DS2-VASc score had consistently high negative predictive value during follow-up and the highest probability of being the best performing clinical score.

Prediction models for atrial fibrillation applicable in the community: a systematic review and meta-analysis

“…Previous systematic reviews have focused on individual predictors for AF, 58 , 59 on AF as a risk factor for other outcomes, 60 , 61 or on risk models for adverse outcomes in AF patients. 62 , 63 However, to our knowledge, this is the first systematic review and meta-analysis on performance of incident AF risk prediction models, and the first with a focus on such risk models validated in and applicable to the community.…”

Impact of atrial fibrillation in critically ill patients admitted to a stepdown unit

“…CHA 2 DS 2 -VASc and HAS-BLED scores are validated and used to evaluate thromboembolic and bleeding risk in AF patients, 25 being associated and able to predict the occurrence of death in AF patients. 26 Nevertheless, validation of these scores is lacking in ICU. Despite the high rate of reported events, our data show that CHA 2 DS 2 -VASc and HAS-BLED are unable to predict stroke and major bleeding.…”

CHA2DS2VASc score and adverse outcomes in middle-aged individuals without atrial fibrillation

“…The CHA 2 DS 2 VASc score (congestive heart failure, hypertension, age ≥ 75 years [doubled], diabetes, stroke/transient ischaemic attack/thromboembolism [doubled], vascular disease [prior myocardial infarction, peripheral artery disease, or aortic plaque], age 65–74 years, sex category [female]), is used to evaluate the risk of thromboembolic events in patients with non-valvular atrial fibrillation (AF), and is recommended by current guidelines to guide the management of antithrombotic therapy. 1, 2 Most of the individual components of the CHA 2 DS 2 VASc score have been considered as risk factors for stroke, irrespective of the presence of AF, and are also included in older stroke risk assessment models, such as the Framingham risk score; 3 furthermore, they have been considered as cardiovascular risk factors in other risk assessment tools that focus on the prediction of overall cardiovascular risk. 4 Many components of the CHA 2 DS 2 VASc score have also been shown to predict outcome after stroke.…”