Key result
GARFIELD-AF improves 1-year stroke discrimination over CHA2DS2-VASc with a C-index of ~0.71.
Why the study?
The study sought to externally validate the accuracy of the GARFIELD-AF model against existing risk scores for stroke and major bleeding in patients with non-valvular AF in a population-based cohort.
Does the GARFIELD-AF model improve prediction of stroke and major bleeding compared to CHA2DS2-VASc and HAS-BLED scores in patients with non-valvular AF?
Cohort (n=90,693)
Yes
Does the GARFIELD-AF model improve prediction of stroke and major bleeding compared to CHA2DS2-VASc and HAS-BLED scores in patients with non-valvular AF?
Effect estimate: C-index 0.71 (95% CI 0.70 to 0.72)
Absolute Event Rate: 0.71% vs 0.67%
p-value: p=<0.001
The GARFIELD-AF model provides superior discrimination for stroke risk compared to CHA2DS2-VASc and comparable discrimination for major bleeding compared to HAS-BLED in patients with non-valvular AF.
May enhance stroke stratification over CHA2DS2-VASc in non-valvular AF; leaves open whether it should guide therapy pending prospective validation.
Objectives To externally validate the accuracy of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) model against existing risk scores for stroke and major bleeding risk in patients with non-valvular AF in a population-based cohort. Design Retrospective cohort study. Setting Danish nationwide registries. Participants 90 693 patients with newly diagnosed non-valvular AF were included between 2010 and 2016, with follow-up censored at 1 year. Primary and secondary outcome measures External validation was performed using discrimination and calibration plots. C-statistics were compared with CHA 2 DS 2 VASc score for ischaemic stroke/systemic embolism (SE) and HAS-BLED score for major bleeding/haemorrhagic stroke outcomes. Results Of the 90 693 included, 51 180 patients received oral anticoagulants (OAC). Overall median age (Q1, Q3) were 75 (66–83) years and 48 486 (53.5%) were male. At 1-year follow-up, a total of 2094 (2.3%) strokes/SE, 2642 (2.9%) major bleedings and 10 915 (12.0%) deaths occurred. The GARFIELD-AF model was well calibrated with the predicted risk for stroke/SE and major bleeding. The discriminatory value of GARFIELD-AF risk model was superior to CHA 2 DS 2 VASc for predicting stroke in the overall cohort (C-index: 0.71, 95% CI: 0.70 to 0.72 vs C-index: 0.67, 95% CI: 0.66 to 0.68, p<0.001) as well as in low-risk patients (C-index: 0.64, 95% CI: 0.59 to 0.69 vs C-index: 0.57, 95% CI: 0.53 to 0.61, p=0.007). The GARFIELD-AF model was comparable to HAS-BLED in predicting the risk of major bleeding in patients on OAC therapy (C-index: 0.64, 95% CI: 0.63 to 0.66 vs C-index: 0.64, 95% CI: 0.63 to 0.65, p=0.60). Conclusion In a nationwide Danish cohort with non-valvular AF, the GARFIELD-AF model adequately predicted the risk of ischaemic stroke/SE and major bleeding. Our external validation confirms that the GARFIELD-AF model was superior to CHA 2 DS 2 VASc in predicting stroke/SE and comparable with HAS-BLED for predicting major bleeding.
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Dalgaard et al. (2019) conducted a cohort in Non-valvular atrial fibrillation (n=90,693). GARFIELD-AF risk model vs. CHA2DS2-VASc score was evaluated on Discriminatory performance (C-index) for 1-year prediction of ischemic stroke or systemic embolism (C-index 0.71, 95% CI 0.70 to 0.72, p=<0.001). The GARFIELD-AF risk model demonstrated superior discrimination compared to the CHA2DS2-VASc score for predicting 1-year ischemic stroke or systemic embolism (C-index 0.71 vs 0.67, p<0.001).
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