Key result
COOL-AF achieves a ~0.73 C-statistic, beating GARFIELD and CHA2DS2-VASc for mortality prediction in Asian AF patients.
Why the study?
To compare the GARFIELD Refitted model and CHA2DS2-VASc/HAS-BLED risk scores with a new model from the COOL-AF registry for predicting death, ischaemic stroke/systemic embolism, and major bleeding in Asian AF patients.
Do the COOL-AF predictive models improve risk prediction for all-cause mortality, SSE, and major bleeding compared to GARFIELD Refitted, CHA2DS2-VASc, and HAS-BLED models in Asian patients with atrial fibrillation?
Cohort (n=3,405)
Yes
Do the COOL-AF predictive models improve risk prediction for all-cause mortality, SSE, and major bleeding compared to GARFIELD Refitted, CHA2DS2-VASc, and HAS-BLED models in Asian patients with atrial fibrillation?
Effect estimate: C-statistic 0.727 (95% CI 0.712-0.742)
The COOL-AF predictive models demonstrated good predictive ability for mortality, stroke, and bleeding in Asian patients with atrial fibrillation, outperforming standard scores like CHA2DS2-VASc for all-cause mortality.
May refine mortality stratification in Asian AF; leaves open prospective validation before clinical adoption.
Background The objectives of this study were to compare the GARFIELD Refitted model and CHA 2 DS 2 ‐VASc/HAS‐BLED risk scores with the new model from the COOL‐AF registry for all‐cause death, ischaemic stroke/systemic embolism (SSE) and major bleeding in Asian patients with atrial fibrillation (AF). Methods Patients with non‐valvular AF in the nationwide COOL‐AF registry were studied. Patients were enrolled from 27 hospitals in Thailand during 2014–2017. Main outcomes were all‐cause mortality, SSE and major bleeding. Predictive models of the three outcomes were developed from the variables in the multivariable Cox‐proportional Hazard model. Predictive values of the models were evaluated by C‐statistics, calibration plots and decision curve analysis (DCA). The new COOL‐AF models were compared with the GARFIELD Refitted models and CHA 2 DS 2 ‐VASc model for all‐cause mortality, SSE/HAS‐BLED model for major bleeding. Results A total of 3405 patients were enrolled. The C‐statistics for the COOL‐AF models were 0.727 (0.712–0.742), 0.708 (0.693–0.724) and 0.706 (0.690–0.721) for all‐cause mortality, SSE and major bleeding, respectively. Calibration plots showed good agreement between predicted probability the observed outcomes for the COOL‐AF models with a calibration slope of 0.94–0.99. The predictive ability remains preserved after the internal validation with bootstraps and optimism (bias) correction. The COOL‐AF predictive models tended to be superior to the GARFIELD Refitted, CHA 2 DS 2 ‐VASc and HAS‐BLED models. Conclusion The COOL‐AF predictive models for all‐cause mortality, SSE and major bleeding in Asian patients with AF had a good predictive ability. The COOL‐AF model for all‐cause mortality was superior to the GARFIELD Refitted and CHA 2 DS 2 ‐VASc model.
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Krittayaphong et al. (2022) conducted a cohort in Non-valvular atrial fibrillation (n=3,405). COOL-AF predictive models vs. GARFIELD Refitted and CHA2DS2-VASc/HAS-BLED models was evaluated on Predictive ability (C-statistic) for all-cause mortality (C-statistic 0.727, 95% CI 0.712-0.742). The COOL-AF predictive model for all-cause mortality yielded a C-statistic of 0.727, proving superior to GARFIELD Refitted and CHA2DS2-VASc models in Asian patients with atrial fibrillation.
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