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Published on: June 30, 2023
LVS-HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency
Linda S B Johnson1,2, Jonas Oldgren3, Tyler W Barrett4
1Department of Clinical Physiology Skåne University Hospital Department of Clinical Sciences Lund University Malmö Sweden.
Insights
A new score, LVS-HARMED, helps predict the 1-year risk of new heart failure (HF) in atrial fibrillation (AF) patients after an emergency department visit. This tool aids in identifying high-risk individuals for preventative strategies.
Area of Science:
- Cardiology
- Public Health
Background:
- Heart failure (HF) is a significant complication of atrial fibrillation (AF), leading to increased hospitalizations and mortality.
- Early identification of AF patients at risk for HF is crucial for improving patient outcomes.
Purpose of the Study:
- To develop and validate a predictive score for new-onset HF within one year following an emergency department (ED) visit for AF.
Main Methods:
- Utilized data from the RE-LY AF registry, enrolling 15,400 patients with AF presenting to an ED across 47 countries.
- Identified independent predictors of new-onset HF, including left ventricular hypertrophy, valvular heart disease, smoking, height, age, rheumatic heart disease, prior myocardial infarction, AF at ED discharge, and diabetes.
- Developed the LVS-HARMED score and validated its predictive performance internally and externally.
Main Results:
- The LVS-HARMED score demonstrated good discrimination for predicting 1-year HF risk (C-statistic 0.735, validated C-statistic 0.699).
- 1-year incidence of HF hospitalization or death ranged from 1.1% in the lowest quartile to 14.4% in the highest quartile of the LVS-HARMED score.
- The score also showed good prediction for incident stroke (C-statistic 0.753).
Conclusions:
- The LVS-HARMED score effectively predicts new-onset heart failure in patients with atrial fibrillation after an ED visit.
- This score can aid clinicians in identifying patients who may benefit from targeted preventative interventions for HF.
Abstract:
Background Heart failure (HF) is a common complication to atrial fibrillation (AF), leading to rehospitalization and death. Early identification of patients with AF at risk for HF might improve outcomes. We aimed to derive a score to predict 1-year risk of new-onset HF after an emergency department (ED) visit with AF. Methods and Results The RE-LY AF (Randomized Evaluation of Long-Term Anticoagulant Therapy) registry enrolled patients with AF presenting to an ED in 47 countries, and followed them for a year. The end point was HF hospitalization and/or HF death. Among 15 400 ED patients, 9765 had no prior HF (mean age, 64.9±14.9 years). Within 1 year, new-onset HF developed in 6.8% of patients, of whom 21% died of HF. Independent predictors of HF included left ventricular hypertrophy (odds ratio [OR], 1.47; 95% CI, 1.19-1.82), valvular heart disease (OR, 1.55; 95% CI, 1.18-2.04), smoking (OR, 1.42; 95% CI, 1.12-1.78), height (OR, 0.93; 95% CI, 0.90-0.95 per 3 cm), age (OR, 1.11; 95% CI, 1.07-1.15 per 5 years), rheumatic heart disease (OR, 1.77, 95% CI, 1.24-2.51), prior myocardial infarction (OR, 1.85; 95% CI, 1.45-2.36), remaining in AF at ED discharge (OR, 1.86; 95% CI, 1.46-2.36), and diabetes (OR, 1.33; 95% CI, 1.09-1.64). A continuous risk prediction score (LVS-HARMED [left ventricular, valvular heart disease, smoking or other tobacco use, height, age, rheumatic heart disease, myocardial infarction, emergency department discharge rhythm, and diabetes]) had good discrimination (C statistic, 0.735; 95% CI, 0.716-0.755). Validation was conducted internally using bootstrapping (optimism-corrected C statistic, 0.705) and externally (C statistic, 0.699). The 1-year incidence of HF hospitalization and/or HF death across quartile groups of the score was 1.1%, 4.5%, 6.9%, and 14.4%, respectively. LVS-HARMED also predicted incident stroke (C statistic, 0.753; 95% CI, 0.728-0.778). Conclusions The LVS-HARMED score predicts new-onset HF after an ED visit for AF. Preventative strategies should be considered in patients with high LVS-HARMED HF risk.
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