Disclosures: The authors report no relevant financial disclosures.
September 20, 2021
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Score predicts high risk for HF after ED visit for AF regardless of economic status

Disclosures: The authors report no relevant financial disclosures.
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A continuous risk prediction score predicted high risk for new-onset HF in patients after ED atrial fibrillation visit, regardless of economic status, according to new data published in the Journal of the American Heart Association.

“Prediction and prevention of HF have received much less attention in AF research and guidelines than stroke prevention,” Linda S. B. Johnson, MD, PhD, clinical assistant in the department of clinical physiology at Skåne University Hospital, the department of clinical Sciences at Lund University, Malmö, Sweden, and the Population Health Research Institute at McMaster University, Hamilton, Ontario, Canada, and colleagues wrote. “Furthermore, despite the high risks of HF in patients with AF, no validated HF prevention programs exist for these patients.”

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Researchers evaluated the RE-LY registry of 15,400 patients with AF who presented to an ED from 164 sites in 47 countries. All patients were followed for 1 year and HF diagnosis was determined according to site discretion. Patients with HF history were excluded from the analysis, leaving 9,765 patients (mean age, 65 years; 54% men) with no prior HF history.

The primary outcome was HF hospitalization and/or HF death.

At 1 year, 6.8% of patients developed new-onset HF and 21% of these patients died. Researchers observed left ventricular hypertrophy (OR = 1.47; 95% CI, 1.19-1.82), valvular heart disease (OR = 1.55; 05% CI, 1.18-2.04), smoking (OR = 1.42; 95% CI, 1.12-1.78), height (OR per 3 cm = 0.93; 95% CI, 0.9-0.95), age (OR per 5 years = 1.11; 95% CI, 1.07-1.15), rheumatic heart disease (OR = 1.77; 95% CI, 1.24-2.51), prior MI (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) were independent predictors for HF.

A continuous risk prediction score made up of all the independent HF predictors, LVS-HARMED, demonstrated good discrimination with a C statistic of 0.735 (95% CI, 0.71-0.75). LVS-HARMED was validated through bootstrapping and externally with C statistics of 0.705 and 0.699, respectively. LVS-HARMED also demonstrated high HF risk despite economic status with a C statistic of 0.847 (95% CI, 0.782-0.913) in low-income countries, 0.708 (95% CI, 0.66-0.756) in lower-middle-income countries, 0.689 (95% CI, 0.648-0.73) in upper-middle-income countries and 0.733 (95% CI, 0.707-0.759) in high-income countries. In addition, LVS-HARMED predicted incident stroke with a C statistic of 0.753 (95% CI, 0.72-0.77).

The 1-year incidence of HF hospitalization and/or death was 1.1% in quartile 1, 4.5% in quartile 2, 6.9% in quartile 3 and 14.4% in quartile 4.

“The risk of new-onset HF is high in patients following an ED visit for AF in all countries, regardless of economic status,” the researchers wrote. “This risk can be quantified using the LVS-HARMED score. Preventative strategies should be considered in patients with high LVS-HARMED HF risk.”