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Prediction of long-term net clinical outcomes using the TIMI-AF score: Comparison with CHA2DS2-VASc and HAS-BLED

José Miguel Rivera-Caravaca1, Vanessa Roldán2, María Asunción Esteve-Pastor3

  • 1Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.

American Heart Journal
|February 16, 2018
PubMed

Insights

The TIMI-AF score showed limited usefulness in predicting net clinical outcomes for atrial fibrillation patients on warfarin. It was not superior to existing CHA2DS2-VASc and HAS-BLED scores in identifying low-risk patients.

Area of Science:

  • Cardiology
  • Clinical Research
  • Pharmacology

Background:

  • The TIMI-AF score was developed to predict net clinical outcomes (NCOs) in atrial fibrillation (AF) patients treated with warfarin.
  • External validation of the TIMI-AF score in real-world clinical practice is lacking.
  • Existing scores like CHA2DS2-VASc and HAS-BLED are used to assess risk in AF patients.

Purpose of the Study:

  • To evaluate the long-term predictive performance of the TIMI-AF score.
  • To compare the TIMI-AF score with CHA2DS2-VASc and HAS-BLED in a real-world cohort of anticoagulated AF patients.
  • To assess the clinical usefulness of the TIMI-AF score in identifying low-risk AF patients.

Main Methods:

  • A cohort of 1156 consecutive AF patients stable on vitamin K antagonist (VKA) therapy was included.
  • The baseline risk of NCOs (stroke, life-threatening bleeding, all-cause mortality) was calculated using the TIMI-AF score.
  • Predictive performance was compared with CHA2DS2-VASc and HAS-BLED during a median follow-up of 6.5 years.

Main Results:

  • During follow-up, 563 NCOs occurred (7.49%/year).
  • TIMI-AF identified 'low-risk' and 'medium-risk' patients with higher event rates than CHA2DS2-VASc and HAS-BLED.
  • The predictive performance of TIMI-AF was not significantly different from CHA2DS2-VASc (0.678 vs 0.677) or HAS-BLED (0.644 vs 0.671).
  • TIMI-AF did not improve discrimination, reclassification, or net benefit compared to existing scores.

Conclusions:

  • The TIMI-AF score has limited usefulness for predicting NCOs in VKA-experienced AF patients over the long term.
  • The TIMI-AF score is not superior to CHA2DS2-VASc and HAS-BLED in identifying low-risk AF patients.
  • Further validation and refinement of risk prediction scores for AF patients are warranted.

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