LVS‐HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency Department: Data from a World‐Wide Registry

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...

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Autores principales:	Linda S. B. Johnson, Jonas Oldgren, Tyler W. Barrett, Candace D. McNaughton, Jorge A. Wong, William F. McIntyre, Clifford L. Freeman, Laura Murphy, Gunnar Engström, Michael Ezekowitz, Stuart J. Connolly, Lizhen Xu, Juliet Nakamya, David Conen, Shrikant I. Bangdiwala, Salim Yusuf, Jeff S. Healey
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	atrial fibrillation epidemiology heart failure prevention risk score risk stratification Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/332df64e8cb04f0f99a12de753c5bfa9
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spelling	oai:doaj.org-article:332df64e8cb04f0f99a12de753c5bfa92021-11-23T11:36:35ZLVS‐HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency Department: Data from a World‐Wide Registry10.1161/JAHA.120.0177352047-9980https://doaj.org/article/332df64e8cb04f0f99a12de753c5bfa92021-09-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.120.017735https://doaj.org/toc/2047-9980Background 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.Linda S. B. JohnsonJonas OldgrenTyler W. BarrettCandace D. McNaughtonJorge A. WongWilliam F. McIntyreClifford L. FreemanLaura MurphyGunnar EngströmMichael EzekowitzStuart J. ConnollyLizhen XuJuliet NakamyaDavid ConenShrikant I. BangdiwalaSalim YusufJeff S. HealeyWileyarticleatrial fibrillationepidemiologyheart failurepreventionrisk scorerisk stratificationDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 18 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation epidemiology heart failure prevention risk score risk stratification Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	atrial fibrillation epidemiology heart failure prevention risk score risk stratification Diseases of the circulatory (Cardiovascular) system RC666-701 Linda S. B. Johnson Jonas Oldgren Tyler W. Barrett Candace D. McNaughton Jorge A. Wong William F. McIntyre Clifford L. Freeman Laura Murphy Gunnar Engström Michael Ezekowitz Stuart J. Connolly Lizhen Xu Juliet Nakamya David Conen Shrikant I. Bangdiwala Salim Yusuf Jeff S. Healey LVS‐HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency Department: Data from a World‐Wide Registry
description	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.
format	article
author	Linda S. B. Johnson Jonas Oldgren Tyler W. Barrett Candace D. McNaughton Jorge A. Wong William F. McIntyre Clifford L. Freeman Laura Murphy Gunnar Engström Michael Ezekowitz Stuart J. Connolly Lizhen Xu Juliet Nakamya David Conen Shrikant I. Bangdiwala Salim Yusuf Jeff S. Healey
author_facet	Linda S. B. Johnson Jonas Oldgren Tyler W. Barrett Candace D. McNaughton Jorge A. Wong William F. McIntyre Clifford L. Freeman Laura Murphy Gunnar Engström Michael Ezekowitz Stuart J. Connolly Lizhen Xu Juliet Nakamya David Conen Shrikant I. Bangdiwala Salim Yusuf Jeff S. Healey
author_sort	Linda S. B. Johnson
title	LVS‐HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency Department: Data from a World‐Wide Registry
title_short	LVS‐HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency Department: Data from a World‐Wide Registry
title_full	LVS‐HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency Department: Data from a World‐Wide Registry
title_fullStr	LVS‐HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency Department: Data from a World‐Wide Registry
title_full_unstemmed	LVS‐HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency Department: Data from a World‐Wide Registry
title_sort	lvs‐harmed risk score for incident heart failure in patients with atrial fibrillation who present to the emergency department: data from a world‐wide registry
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/332df64e8cb04f0f99a12de753c5bfa9
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LVS‐HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency Department: Data from a World‐Wide Registry

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