Incidence and Predictors of Heart Failure in Patients With Atrial Fibrillation
Key result
A derived clinical risk score predicted first heart failure hospitalization in patients with atrial fibrillation with a C-statistic of 0.717 (95% CI 0.705-0.732).
Why the study?
Heart failure is a frequent cause of hospitalization and death in atrial fibrillation patients, and identifying those at risk could help select individuals for intensive follow-up and treatment.
Population
23,503 AF patients pooled from 3 randomized trials (ACTIVE-A, RE-LY, AVERROES)
Design
Pooled cohort study for risk score derivation and internal validation
Follow-up
Mean 2.0 years
Authors
Discussion
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Member takes
Implication
May inform HF risk stratification in AF; hypothesis-generating and requires external validation.
Key Points
- To derive and internally validate a clinical risk score predicting first heart failure hospitalization among patients with atrial fibrillation.
- Pooled individual patient data from 3 randomized trials (ACTIVE-A, RE-LY, and AVERROES) comprising 23,503 patients with atrial fibrillation (mean age 71.3 years, 62% male).
- Followed patients over a mean duration of 2.0 years to assess primary endpoints of first heart failure hospitalization and secondary endpoints of cardiovascular death and their composite.
- During follow-up, 875 patients (3.7%; incidence rate 1.85 per 100 patient-years) had a first heart failure hospitalization, and 1037 patients (4.4%; 2.15 per 100 patient-years) died from cardiovascular causes.
- Independent predictors included age, weight, heart rate, serum creatinine, lower height and systolic blood pressure, diabetes, vascular disease, valvular disease, rhythm, left ventricular hypertrophy, and intraventricular conduction delay (C-statistic 0.717, 95% CI 0.705–0.732).
- Incidence rates of heart failure hospitalization increased across risk-score quintiles from 0.49 to 4.51 per 100 patient-years, reaching a 6.8% absolute 2-year risk in the highest quintile.
Study Design
Type
Cohort (n=23,503)
Multicenter
Yes
Structured PICO
P
Population
23,503 patients with atrial fibrillation pooled from 3 randomized trials, followed for a mean of 2.0 years.
O
Outcome
First heart failure hospitalizationhard clinical
Main Result
Effect estimate: C-statistic 0.717 (95% CI 0.705-0.732)
A novel risk score based on clinical characteristics can identify patients with atrial fibrillation at high risk for new-onset heart failure hospitalization.
Cite This Study
Krisai et al. (2021) conducted a cohort in Atrial Fibrillation (n=23,503). Clinical risk score was evaluated on first HF hospitalization (C-statistic 0.717, 95% CI 0.705-0.732). A derived clinical risk score predicted first heart failure hospitalization in patients with atrial fibrillation with a C-statistic of 0.717 (95% CI 0.705-0.732).