Atrial fibrillation and prediction of mortality by conventional clinical score systems according to the setting of care

Diemberger, Igor; Fantecchi, Elisa; Reggiani, Maria Letizia Bacchi; Martignani, Cristian; Angeletti, Andrea; Massaro, Giulia; Ziacchi, Matteo; Biffi, Mauro; Lip, Gregory Y.H.; Boriani, Giuseppe

doi:10.1016/j.ijcard.2018.03.058

Cited by 8 publications

(8 citation statements)

References 25 publications

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“…In a paper investigating the ability of predicting all-cause death in 1051 atrial fibrillation patients, all risk scores presented modest c-indexes ranging from 0.639 for HAS-BLED to 0.706 for CHADS 2 . 28 Our results confirm and extend this evidence, supported by a detailed extensive analysis of available literature.…”

Section: Discussionsupporting

confidence: 87%

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

Proietti

Farcomeni

Romiti

et al. 2018

Eur J Prev Cardiolog

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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.

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Section: Discussionsupporting

confidence: 87%

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

Proietti

Farcomeni

Romiti

et al. 2018

Eur J Prev Cardiolog

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“… 137 Notably, both diseases are promoted by inflammation and share many risk factors: hypertension, DM, sleep apnoea, obesity, and smoking. 138 Despite many authors reported an association between atherosclerosis and AF, we have limited data confirming this hypothesis in prospective cohorts of patients without clinical manifestations of AF or CAD. 139 Two large registries show a close relationship between CT assessed calcium score and later occurrence of AF, while an analysis from the Danish registry evidenced a correlation with baseline calcium score (area under the curve 0.68) especially for values ≥1000.…”

Section: Af and Comorbidities: Clinical Implications And Translational Perspectivesmentioning

confidence: 76%

Optimizing indices of atrial fibrillation susceptibility and burden to evaluate atrial fibrillation severity, risk and outcomes

Boriani

Vitolo

Diemberger

et al. 2021

Cardiovascular Research

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Atrial fibrillation (AF) has heterogeneous patterns of presentation concerning symptoms, duration of episodes, AF burden, and the tendency to progress towards the terminal step of permanent AF. AF is associated with a risk of stroke/thromboembolism traditionally considered dependent on patient-level risk factors rather than AF type, AF burden or other characterizations. However, the time spent in AF appears related to an incremental risk of stroke, as suggested by the higher risk of stroke in patients with clinical AF versus subclinical episodes and in patients with non-paroxysmal AF versus paroxysmal AF. In patients with device-detected atrial tachyarrhythmias, AF burden is a dynamic process with potential transitions from a lower to a higher maximum daily arrhythmia burden, thus justifying monitoring its temporal evolution. In clinical terms, the appearance of the first episode of AF, the characterization of the arrhythmia in a specific AF type, the progression of AF, and the response to rhythm control therapies, as well as the clinical outcomes, are all conditioned by underlying heart disease, risk factors, and comorbidities. Improved understanding is needed on how to monitor and modulate the effect of factors that condition AF susceptibility and modulate AF-associated outcomes. The increasing use of wearables and apps in practice and clinical research may be useful to predict and quantify AF burden and assess AF susceptibility at the individual patient level. This may help us reveal why AF stops and starts again, or why AF episodes, or burden, cluster. Additionally, whether the distribution of burden is associated with variations in the propensity to thrombosis or other clinical adverse events. Combining the improved methods for data analysis, clinical and translational science could be the basis for the early identification of the subset of patients at risk of progressing to a longer duration/higher burden of AF and the associated adverse outcomes.

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“…In view of its epidemiological profile, AF affects subjects in the range of age at highest risk of adverse outcomes if infected by Sars-Cov-2 [33] and the caution in avoiding admissions to hospital may explain the important reduction in acute pharmacological and non-pharmacological treatments applied for AF in emergency setting reported during the study period, as reported in this survey. Since appropriate prescription of oral anticoagulants in patients at risk of stroke is a major determinant of outcome at long term [34][35][36][37][38][39][40], it will be necessary in the near future to establish even stricter connections between hospital and out of hospital care, for a re-assessment of patients who presented AF and these months with regard to clinical evaluation and appropriateness of treatment for ensuring continuity of care. It will also be interesting to assess to what extent untreated or undiscovered AF occurred during the lockdown will result in major consequences, such as syncope, heart failure, stroke/systemic embolism [41][42][43].…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 pandemic on the clinical activities related to arrhythmias and electrophysiology in Italy: results of a survey promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

Boriani

Palmisano²,

Guerra

et al. 2020

Intern Emerg Med

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COVID-19 outbreak had a major impact on the organization of care in Italy, and a survey to evaluate provision of for arrhythmia during COVID-19 outbreak (March-April 2020) was launched. A total of 104 physicians from 84 Italian arrhythmia centres took part in the survey. The vast majority of participating centres (95.2%) reported a significant reduction in the number of elective pacemaker implantations during the outbreak period compared to the corresponding two months of year 2019 (50.0% of centres reported a reduction of > 50%). Similarly, 92.9% of participating centres reported a significant reduction in the number of implantable cardioverter-defibrillator (ICD) implantations for primary prevention, and 72.6% a significant reduction of ICD implantations for secondary prevention (> 50% in 65.5 and 44.0% of the centres, respectively). The majority of participating centres (77.4%) reported a significant reduction in the number of elective ablations (> 50% in 65.5% of the centres). Also the interventional procedures performed in an emergency setting, as well as acute management of atrial fibrillation had a marked reduction, thus leading to the conclusion that the impact of COVID-19 was disrupting the entire organization of health care, with a massive impact on the activities and procedures related to arrhythmia management in Italy.

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Atrial fibrillation and prediction of mortality by conventional clinical score systems according to the setting of care

Abstract: Risk scores currently adopted for decision making on starting oral anticoagulation provide good prediction of long-term survival in unselected AF patients, especially in the outpatient setting.

Cited by 8 publications

References 25 publications

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

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

Optimizing indices of atrial fibrillation susceptibility and burden to evaluate atrial fibrillation severity, risk and outcomes

Impact of COVID-19 pandemic on the clinical activities related to arrhythmias and electrophysiology in Italy: results of a survey promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

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