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Evaluation of the Presence of Native Valvular Disease in Patients With Atrial Fibrillation Using the EHRA (Evaluated

Antonio Escolar Conesa1, María Asunción Esteve-Pastor2,3,4, Vanessa Roldán3,5

  • 1Department of Cardiology, Hospital Comarcal del Noroeste, Murcia, Spain.

Clinical Cardiology
|July 31, 2025
PubMed

Insights

Patients with atrial fibrillation and native valvular heart disease (EHRA 2) face worse outcomes, including higher mortality and major adverse cardiovascular events, compared to those without valve disease (EHRA 3). Native valve disease is an independent risk factor for adverse events.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Clinical Research

Background:

  • Atrial fibrillation (AF) frequently coexists with native valvular heart disease (VHD), creating a complex clinical scenario.
  • The EHRA classification system categorizes patients based on valve status: EHRA 1 (mechanical/severe mitral stenosis), EHRA 2 (native VHD/biological prosthesis), and EHRA 3 (no valve disease).

Purpose of the Study:

  • To analyze clinical characteristics and adverse events in patients with AF on oral anticoagulation, stratified by the EHRA classification.
  • To determine the prognostic impact of native valvular involvement in anticoagulated AF patients.

Main Methods:

  • A multicenter retrospective observational study.
  • Inclusion of 1,399 patients with AF initiating oral anticoagulation.
  • Collection of clinical, analytical, and echocardiographic data, along with adverse event monitoring during follow-up.

Main Results:

  • Patients classified as EHRA 2 (native valve involvement) constituted 63% of the cohort.
  • EHRA 2 patients exhibited significantly higher rates of cardiovascular mortality and major adverse cardiovascular events (MACE) compared to EHRA 3 patients.
  • Multivariate analysis confirmed that the EHRA 2 group was independently associated with all major adverse events.

Conclusions:

  • Native valvular heart disease in anticoagulated AF patients (EHRA 2) is associated with a poorer prognosis than no valve involvement (EHRA 3).
  • Native valvular disease emerges as an independent risk factor for all-cause mortality, major bleeding, cardiovascular mortality, acute coronary syndrome, heart failure, and MACE.
Abstract

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