Key result
The ABC-death risk score yielded higher c-indices for predicting all-cause mortality than a clinical variables model in both derivation (0.74 vs. 0.68) and validation (0.74 vs. 0.67) cohorts.
Why the study?
Does the ABC-death risk score improve prediction of all-cause mortality compared to clinical variables alone in anticoagulated patients with atrial fibrillation?
Observational (n=23,159)
Yes
Does the ABC-death risk score improve prediction of all-cause mortality compared to clinical variables alone in anticoagulated patients with atrial fibrillation?
Absolute Event Rate: 0.74% vs 0.68%
The ABC-death risk score, incorporating age, heart failure, NT-proBNP, troponin-T, and GDF-15, improves mortality prediction in anticoagulated patients with atrial fibrillation compared to clinical variables alone.
May aid mortality risk stratification in anticoagulated AF; hypothesis-generating and requires prospective validation before practice change.
Aims: In atrial fibrillation (AF), mortality remains high despite effective anticoagulation. A model predicting the risk of death in these patients is currently not available. We developed and validated a risk score for death in anticoagulated patients with AF including both clinical information and biomarkers. Methods and results: The new risk score was developed and internally validated in 14 611 patients with AF randomized to apixaban vs. warfarin for a median of 1.9 years. External validation was performed in 8548 patients with AF randomized to dabigatran vs. warfarin for 2.0 years. Biomarker samples were obtained at study entry. Variables significantly contributing to the prediction of all-cause mortality were assessed by Cox-regression. Each variable obtained a weight proportional to the model coefficients. There were 1047 all-cause deaths in the derivation and 594 in the validation cohort. The most important predictors of death were N-terminal pro B-type natriuretic peptide, troponin-T, growth differentiation factor-15, age, and heart failure, and these were included in the ABC (Age, Biomarkers, Clinical history)-death risk score. The score was well-calibrated and yielded higher c-indices than a model based on all clinical variables in both the derivation (0.74 vs. 0.68) and validation cohorts (0.74 vs. 0.67). The reduction in mortality with apixaban was most pronounced in patients with a high ABC-death score. Conclusion: A new biomarker-based score for predicting risk of death in anticoagulated AF patients was developed, internally and externally validated, and well-calibrated in two large cohorts. The ABC-death risk score performed well and may contribute to overall risk assessment in AF. ClinicalTrials.gov identifier: NCT00412984 and NCT00262600.
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Hijazi et al. (2017) conducted an observational in Atrial fibrillation (n=23,159). ABC-death risk score vs. Clinical variables model was evaluated on All-cause mortality prediction (c-index). The ABC-death risk score yielded higher c-indices for predicting all-cause mortality than a clinical variables model in both derivation (0.74 vs. 0.68) and validation (0.74 vs. 0.67) cohorts.
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