Association between clinical risk scores and mortality in atrial fibrillation: Systematic review and network meta-regression of 669,000 patients

Many clinical scores for risk stratification in patients with atrial fibrillation have been proposed, and some have been useful in predicting all-cause mortality. We aim to analyse the relationship between clinical risk score and all-cause death occurrence in atrial fibrillation patients. We perform...

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Veröffentlicht in:European journal of preventive cardiology Jg. 27; H. 6; S. 633
Hauptverfasser: Proietti, Marco, Farcomeni, Alessio, Romiti, Giulio Francesco, Di Rocco, Arianna, Placentino, Filippo, Diemberger, Igor, Lip, Gregory Yh, Boriani, Giuseppe
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England 01.04.2020
Schlagworte:
Aged
Aged, 80 and over
Atrial Fibrillation - diagnosis
Atrial Fibrillation - mortality
Cause of Death
Decision Support Techniques
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Risk Assessment
Risk Factors
Time Factors
mortality
risk assessment
outcomes
Atrial fibrillation
prognostic risk scores
ISSN:2047-4881, 2047-4881
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Zusammenfassung:Many clinical scores for risk stratification in patients with atrial fibrillation have been proposed, and some have been useful in predicting all-cause mortality. We aim to analyse the relationship between clinical risk score and all-cause death occurrence in atrial fibrillation patients. We performed a systematic search in PubMed and Scopus from inception to 22 July 2017. We considered the following scores: ATRIA-Stroke, ATRIA-Bleeding, CHADS , CHA DS -VASc, HAS-BLED, HATCH and ORBIT. Papers reporting data about scores and all-cause death rates were considered. Fifty studies and 71 scores groups were included in the analysis, with 669,217 patients. Data on ATRIA-Bleeding, CHADS , CHA DS -VASc and HAS-BLED were available. All the scores were significantly associated with an increased risk for all-cause death. All the scores showed modest predictive ability at five years (c-indexes (95% confidence interval) CHADS : 0.64 (0.63-0.65), CHA DS -VASc: 0.62 (0.61-0.64), HAS-BLED: 0.62 (0.58-0.66)). Network meta-regression found no significant differences in predictive ability. CHA DS -VASc score had consistently high negative predictive value (≥94%) at one, three and five years of follow-up; conversely it showed the highest probability of being the best performing score (63% at one year, 60% at three years, 68% at five years). In atrial fibrillation patients, contemporary clinical risk scores are associated with an increased risk of all-cause death. Use of these scores for death prediction in atrial fibrillation patients could be considered as part of holistic clinical assessment. The CHA DS -VASc score had consistently high negative predictive value during follow-up and the highest probability of being the best performing clinical score.
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ISSN:2047-4881
2047-4881
DOI:10.1177/2047487318817662