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Ability of the DANCAMI to predict the risk ischemic stroke and mortality in patients with atrial fibrillation/flutter
Kasper Bonnesen1, Uffe Heide-Jørgensen1, Henrik Toft Sørensen1
1Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark.
Insights
The Danish Comorbidity Index for Acute Myocardial Infarction (DANCAMI) effectively predicts mortality in atrial fibrillation patients. DANCAMI showed similar performance to other indices for stroke and cardiovascular death, but outperformed others for all-cause mortality prediction.
Area of Science:
- Cardiology
- Epidemiology
- Health Services Research
Background:
- Atrial fibrillation/flutter (AF) is a common arrhythmia associated with increased risk of stroke and mortality.
- Accurate prediction of outcomes in AF patients is crucial for risk stratification and management.
- Existing comorbidity indices may vary in their predictive performance for specific outcomes in AF.
Purpose of the Study:
- To compare the predictive performance of the Danish Comorbidity Index for Acute Myocardial Infarction (DANCAMI) against established indices.
- To evaluate the ability of DANCAMI, Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), and CHA₂DS₂-VASc score to predict ischemic stroke, cardiovascular mortality, and all-cause mortality in patients with atrial fibrillation/flutter.
Main Methods:
- A large-scale, population-based cohort study included 361,901 Danish patients diagnosed with incident atrial fibrillation/flutter between 2000 and 2020.
- The discriminatory performance of DANCAMI, CCI, ECI, and CHA₂DS₂-VASc was assessed using C-statistics.
- Predictions were made for 1-year and 5-year risks of ischemic stroke, cardiovascular mortality, and all-cause mortality, with models including age and sex +/- individual indices.
Main Results:
- For ischemic stroke, all models demonstrated similar predictive performance (5-year C-statistic ≈ 0.64).
- Predictive performance for cardiovascular mortality was also similar across all models (5-year C-statistic ≈ 0.76).
- DANCAMI, CCI, and ECI showed superior prediction of 5-year all-cause mortality compared to the baseline and CHA₂DS₂-VASc models (0.75 vs. 0.71).
Conclusions:
- The DANCAMI demonstrates comparable predictive accuracy to CCI, ECI, and CHA₂DS₂-VASc for ischemic stroke and cardiovascular mortality in atrial fibrillation patients.
- DANCAMI offers similar or better prediction of all-cause mortality compared to CCI, ECI, and CHA₂DS₂-VASc in this population.
- DANCAMI is a valuable tool for risk assessment in patients with atrial fibrillation/flutter, particularly for predicting all-cause mortality.
Objectives:
Comparison of the danish comorbidity index for acute myocardial infarction (DANCAMI), the charlson comorbidity index (CCI), the elixhauser comorbidity index (ECI), and the CHA2DS2-VASc score to predict ischemic stroke, cardiovascular mortality, and all-cause mortality after atrial fibrillation/flutter.
Materials And Methods:
A population-based cohort study of all Danish patients with incident atrial fibrillation/flutter during 2000-2020 (n=361,901). C-Statistics were used to evaluate the discriminatory performance for predicting 1 and 5-year risks of the outcomes for a baseline model (including age and sex) +/- the individual indices.
Results:
For the DANCAMI, the 5-year risk did not increase with comorbidity burden for ischemic stroke (5.9% for low vs. 5.6% for severe) but did increase for cardiovascular mortality (10% for low vs. 16% for severe) and all-cause mortality (33% for low vs. 61% for severe). C-Statistics for predicting 5-year ischemic stroke risk were similar for all models (0.64). C-Statistics for predicting 5-year cardiovascular mortality risk were also similar for the baseline (0.76), the DANCAMI (0.77), the CCI (0.76), the ECI (0.76), and the CHA2DS2-VASc (0.76) models. C-Statistics for predicting 5-year all-cause mortality risk were lower for the baseline (0.71) and the CHA2DS2-VASc (0.71) models than for the DANCAMI (0.75), the CCI (0.74), and the ECI (0.74) models. The 1-year C-Statistics were comparable.
Conclusion:
The DANCAMI predicted ischemic stroke and cardiovascular mortality risks similar to the CCI, the ECI, and the CHA2DS2-VASc. The DANCAMI predicted all-cause mortality risk similar to the CCI and the ECI, but better than the baseline and the CHA2DS2-VASc.
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