Dataset Information

Predicting Heart Failure in Patients with Atrial Fibrillation: A Report from the Prospective COOL-AF Registry.

ABSTRACT:

Background

This study aimed to determine risk factors and incidence rate and develop a predictive risk model for heart failure for Asian patients with atrial fibrillation (AF).

Methods

This is a prospective multicenter registry of patients with non-valvular AF in Thailand conducted between 2014 and 2017. The primary outcome was the occurrence of an HF event. A predictive model was developed using a multivariable Cox-proportional model. The predictive model was assessed using C-index, D-statistics, Calibration plot, Brier test, and survival analysis.

Results

There were a total of 3402 patients (average age 67.4 years, 58.2% male) with mean follow-up duration of 25.7 ± 10.6 months. Heart failure occurred in 218 patients during follow-up, representing an incidence rate of 3.03 (2.64-3.46) per 100 person-years. There were ten HF clinical factors in the model. The predictive model developed from these factors had a C-index and D-statistic of 0.756 (95% CI: 0.737-0.775) and 1.503 (95% CI: 1.372-1.634), respectively. The calibration plots showed a good agreement between the predicted and observed model with the calibration slope of 0.838. The internal validation was confirmed using the bootstrap method. The Brier score indicated that the model had a good prediction for HF.

Conclusions

We provide a validated clinical HF predictive model for patients with AF, with good prediction and discrimination values.

SUBMITTER: Krittayaphong R

PROVIDER: S-EPMC9967148 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Publications

Predicting Heart Failure in Patients with Atrial Fibrillation: A Report from the Prospective COOL-AF Registry.

Krittayaphong Rungroj R Chichareon Ply P Komoltri Chulalak C Sairat Poom P Lip Gregory Y H GYH

Journal of clinical medicine 20230206 4

<h4>Background</h4>This study aimed to determine risk factors and incidence rate and develop a predictive risk model for heart failure for Asian patients with atrial fibrillation (AF).<h4>Methods</h4>This is a prospective multicenter registry of patients with non-valvular AF in Thailand conducted between 2014 and 2017. The primary outcome was the occurrence of an HF event. A predictive model was developed using a multivariable Cox-proportional model. The predictive model was assessed using C-ind ...[more]

PMID: 36835801

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Project description:BackgroundThe COOL-AF (Cohort of Antithrombotic Use and Optimal International Normalized Ratio Levels in Patients with Atrial Fibrillation) risk scores for death, bleeding, and thromboembolic events (TEs) were derived from the COOL-AF cohort from Thailand and require external validation.ObjectivesThe authors sought to externally validate the COOL-AF scores in the APHRS (Asia-Pacific Heart Rhythm Society) registry and to compare their performance in the ESC-EHRA (European Society of Cardiology-European Heart Rhythm Association) EORP-AF (EURObservational Research Programme in Atrial Fibrillation) General Long-Term Registry.MethodsWe studied 3,628 APHRS and 8,825 EORP-AF patients. Receiver operating characteristic (ROC) curves and Cox regression analyses were used to test the predictive value of COOL-AF scores and to compared them with the CHA2DS2-VASc and HAS-BLED scores.ResultsPatients in the EORP-AF were older, had a higher prevalence of male sex, and were at higher thromboembolic and hemorrhagic risk than APHRS patients. After 1 year of follow-up in APHRS and EORP-AF, the following events were recorded: 87 (2.4%) and 435 (4.9%) death for any causes, 37 (1.0%) and 111 (1.3%) major bleeding, and 25 (0.7%) and 109 (1.2%) TEs, respectively. In APHRS, the COOL-AF scores showed moderate-to-good predictive value for all-cause mortality (area under the curve [AUC]: 0.77; 95% CI: 0.71-0.83), major bleeding (AUC: 0.68; 95% CI: 0.60-0.76), and TEs (AUC: 0.61; 95% CI: 0.51-0.71), and were similar to the CHA2DS2-VASc and HAS-BLED scores. In EORP-AF, the predictive value of COOL-AF for all-cause mortality (AUC: 0.68; 95% CI: 0.65-0.70) and major bleeding (AUC: 0.61; 95% CI: 0.60-0.62) was modest and lower than in APHRS. In EORP-AF, the COOL-AF score for TE was inferior to the CHA2DS2-VASc score.ConclusionsThe COOL-AF risk scores may be an easy tool to identify Asian patients with AF at risk for death and major bleeding and performs better in Asian than in European patients with AF. (Clinical Survey on the Stroke Prevention in Atrial Fibrillation in Asia [AF-Registry]; NCT04807049).

Project description:BackgroundIdentifying asymptomatic patients with atrial fibrillation (AF) poses a challenge, and their optimal management is less certain, despite similar outcomes to symptomatic AF patients. The 'Atrial fibrillation Better Care' (ABC) pathway has been recently proposed as a holistic or integrated care approach for the comprehensive management of symptomatic patients with AF. We aimed to determine the use of the ABC pathway on clinical outcomes in asymptomatic patients with AF.MethodsThis is a prospective multicenter registry of patients with non-valvular AF in Thailand conducted between 2014 and 2017. Patients were characterized based on AF-related symptoms at enrollment and their adherence or non-adherence to the ABC pathway. Follow-up data were collected for 3 years to examine the composite endpoint (all-cause death, ischemic stroke/transient ischemic attack [TIA]/systemic embolism [SE], and major bleeding), and the impact of adherence to the ABC pathway.ResultsOf a total of 3405 patients included in the study, 785 (23 %) (mean age 69.0 years, 63.7 % male) were asymptomatic at enrollment. Among these asymptomatic patients, 346 (44 %) were adherent to the ABC pathway. Adherence to the ABC pathway was associated with a significantly lower rate of composite endpoints compared to non-adherence (hazard ratio [HR] 0.63, 95 % confidence interval [CI] 0.45-0.90, p = 0.01). Adherence to the ABC pathway was also associated with lower all-cause mortality rates (HR 0.55, 95 % CI 0.35-0.85, p = 0.007). After adjusting for age, gender, and baseline comorbidities, adherence to the ABC pathway remained significantly associated with a lower rate of composite endpoints (HR 0.69, 95 % CI 0.49-0.98, p = 0.03) and all-cause death (HR 0.58, 95 % CI 0.38-0.90, p = 0.01) compared to non-adherence. Subgroup analyses based on sex, age, AF type, risk scores, and comorbidities consistently demonstrated lower hazard ratios for the composite endpoint among patients who were adherent to the ABC pathway.ConclusionsIn patients with AF who were asymptomatic, adherence to the ABC pathway was associated with a lower composite endpoint of all-cause death, ischemic stroke/TIA/SE, and major bleeding. This benefit was seen irrespective of sex, age, AF type, risk scores, and comorbidities.

Project description:ObjectiveTo determine the effect of gender on clinical outcomes of Asian non-valvular atrial fibrillation patients.DesignThis is a cohort study.Setting27 university and regional hospitals in Thailand.ParticipantsPatients with non-valvular atrial fibrillation.Primary and secondary outcomes measuresThe clinical outcomes were ischaemic stroke/transient ischaemic attack (TIA), major bleeding, intracerebral haemorrhage (ICH), heart failure and death. Follow-up data were recorded every 6 months until 3 years. Differences in clinical outcomes between males and females were determined. Multivariate analysis was performed to assess the effect of gender on clinical outcomes. Survival analysis and log-rank test were performed to determine the time-dependent effect of clinical outcomes, and the difference between males and females. Effect of oral anticoagulant (OAC) on outcomes and net clinical benefit of OAC was assessed. The analysis was performed both for the whole dataset and propensity score matching with multiple imputation.ResultsA total of 3402 patients (mean age: 67.4±11.3 years; 58.2% male) were included. Average follow-up duration 25.7±10.6 months (7192.6 persons-year). Rate of ischaemic stroke/TIA, major bleeding, ICH, heart failure and death were 1.43 (1.17-1.74), 2.11 (1.79-2.48), 0.70 (0.52-0.92), 3.03 (2.64-3.46) and 3.77 (3.33-4.25) per 100 person-years. Females had increased risk for ischaemic stroke/TIA and heart failure and males had increased risk for major bleeding and ICH. Ischaemic stroke/TIA risk in females and major bleeding and ICH risk in males remained even after correction for age, comorbid conditions and anticoagulation treatment. OAC reduced the risk of ischaemic stroke/TIA in males and females, and markedly increased the risk of major bleeding and ICH in males.ConclusionsFemales had a higher risk of ischaemic stroke/TIA and heart failure, and a lower risk of major bleeding and ICH compared with males. OAC reduced risk of ischaemic stroke/TIA in females, and markedly increased risk of major bleeding and ICH in males.

Dataset Information

Predicting Heart Failure in Patients with Atrial Fibrillation: A Report from the Prospective COOL-AF Registry.

Background

Methods

Results

Conclusions

Publications

Predicting Heart Failure in Patients with Atrial Fibrillation: A Report from the Prospective COOL-AF Registry.

Similar Datasets

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