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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

Johnson, Linda S.B. LU ; Oldgren, Jonas ; Barrett, Tyler W. ; McNaughton, Candace D. ; Wong, Jorge A. ; McIntyre, William F. ; Freeman, Clifford L. ; Murphy, Laura ; Engström, Gunnar LU and Ezekowitz, Michael , et al. (2021) In Journal of the American Heart Association 10(18).
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... (More)

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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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Atrial fibrillation, Epidemiology, Heart failure, Prevention, Risk score, Risk stratification
in
Journal of the American Heart Association
volume
10
issue
18
article number
e017735
publisher
Wiley-Blackwell
external identifiers
  • scopus:85116542893
  • pmid:34514842
ISSN
2047-9980
DOI
10.1161/JAHA.120.017735
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
id
c5d9d013-d6af-4456-820e-b2617d22f49f
date added to LUP
2021-10-26 11:24:27
date last changed
2024-06-15 19:09:27
@article{c5d9d013-d6af-4456-820e-b2617d22f49f,
  abstract     = {{<p>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.</p>}},
  author       = {{Johnson, Linda S.B. and Oldgren, Jonas and Barrett, Tyler W. and McNaughton, Candace D. and Wong, Jorge A. and McIntyre, William F. and Freeman, Clifford L. and Murphy, Laura and Engström, Gunnar and Ezekowitz, Michael and Connolly, Stuart J. and Xu, Lizhen and Nakamya, Juliet and Conen, David and Bangdiwala, Shrikant I. and Yusuf, Salim and Healey, Jeff S.}},
  issn         = {{2047-9980}},
  keywords     = {{Atrial fibrillation; Epidemiology; Heart failure; Prevention; Risk score; Risk stratification}},
  language     = {{eng}},
  month        = {{09}},
  number       = {{18}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  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}},
  url          = {{http://dx.doi.org/10.1161/JAHA.120.017735}},
  doi          = {{10.1161/JAHA.120.017735}},
  volume       = {{10}},
  year         = {{2021}},
}