The ABC death risk score: is it time to start measuring GDF-15?

This editorial refers to ‘A biomarker-based risk score to predict death in patients with atrial fibrillation: the ABC (age, biomarkers, clinical history) death risk score’†, by Z. Hijazi et al., on page 477. Assessing risk of morbidity and mortality is an important aspect of caring for patients with heart disease that guides patient counselling and implementation of therapies. As the pathophysiological mechanisms involved in cardiovascular disease are multiple and complex, combining factors that reflect different components of the pathophysiology into a risk score can help provide an overall indication of risk. Ideally a clinical risk score is comprised of data that are readily available to clinicians. Most of the risk scores for predicting stroke or bleeding in atrial fibrillation (AF) follow this rule (i.e. CHADS-VASC, HAS-BLED, ORBIT, and ATRIA).1–4 In this issue of the journal, Dr Hijazi and colleagues5 have derived a clinical risk score, the ABC death risk score, which includes measurement of GDF-15 (growth differentiation factor 15)—a biomarker recently made available for clinical laboratories. The results of their study leave us to consider the questions of whether our hospitals and clinics should make the investment to begin measuring GDF-15, and would a risk score to predict mortality in anti-coagulated patients with AF be useful to our practice.