December 1, 2017Open Access
Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation
Key Result
The integrated GARFIELD-AF risk tool effectively predicted 1-year all-cause mortality (C-statistic 0.75; 95% CI 0.73-0.77) and stroke or systemic embolism (C-statistic 0.68; 95% CI 0.62-0.74).
Study Design
Type
Observational (n=39,898)
Multicenter
Yes
Structured PICO
Does the GARFIELD-AF risk tool improve prediction of mortality, stroke, and bleeding compared to CHA2DS2-VASc and HAS-BLED in patients with atrial fibrillation?
P
Population
39,898 patients with atrial fibrillation from the prospective GARFIELD-AF registry (derivation) and an independent dataset ORBIT-AF (validation).
I
Intervention
GARFIELD-AF integrated risk tool
C
Comparator
CHA2DS2-VASc score (for stroke and mortality) and HAS-BLED score (for bleeding)
O
Outcome
Prediction of 1-year all-cause mortality, stroke or systemic embolism, and bleedinghard clinical
The GARFIELD-AF tool provides an integrated, web-based method for predicting 1-year mortality, stroke, and bleeding in patients with atrial fibrillation, performing well in external validation.
Main Result
Effect estimate: C-statistic 0.75 (95% CI 0.73 to 0.77)
Abstract
OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: -VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: -VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: -VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710).
Cite This Study
Fox et al. (Fri,) conducted a observational in Atrial fibrillation (n=39,898). GARFIELD-AF risk tool vs. CHA2DS2-VASc and HAS-BLED scores was evaluated on 1-year all-cause mortality (C-statistic 0.75, 95% CI 0.73 to 0.77). The integrated GARFIELD-AF risk tool effectively predicted 1-year all-cause mortality (C-statistic 0.75; 95% CI 0.73-0.77) and stroke or systemic embolism (C-statistic 0.68; 95% CI 0.62-0.74).