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GARFIELD-AF risk score for mortality, stroke, and bleeding within 2 years in patients with atrial fibrillation
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Fox, Keith A. A., Virdone, Saverio, Pieper, Karen S., Bassand, Jean-Pierre, Camm, A John, Fitzmaurice, David A., Goldhaber, Samuel Z., Goto, Shinya, Haas, Sylvia, Kayani, Gloria, Oto, Ali, Misselwitz, Frank, Piccini, Jonathan P., Dalgaard, Frederik, Turpie, Alexander G. G., Verheugt, Freek W. A. and Kakkar, Ajay K. (2022) GARFIELD-AF risk score for mortality, stroke, and bleeding within 2 years in patients with atrial fibrillation. European Heart Journal - Quality of Care and Clinical Outcomes, 8 (2). pp. 214-227. doi:10.1093/ehjqcco/qcab028
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WRAP-GARFIELD-AF risk-score-mortality-stroke-bleeding-within-2 years-patients-atrial-fibrillation-2022.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons: Attribution-Noncommercial 4.0. Download (1465Kb) | Preview |
Official URL: https://doi.org/10.1093/ehjqcco/qcab028
Abstract
Aims To determine whether the Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF) integrated risk tool predicts mortality, non-haemorrhagic stroke/systemic embolism, and major bleeding for up to 2 years after new-onset AF and to assess how this risk tool performs compared with CHA2DS2-VASc and HAS-BLED. Methods and results Potential predictors of events included demographic and clinical characteristics, choice of treatment, and lifestyle factors. A Cox proportional hazards model was identified for each outcome by least absolute shrinkage and selection operator methods. Indices were evaluated in comparison with CHA2DS2-VASc and HAS-BLED risk predictors. Models were validated internally and externally in ORBIT-AF and Danish nationwide registries. Among the 52 080 patients enrolled in GARFIELD-AF, 52 032 had follow-up data. The GARFIELD-AF risk tool outperformed CHA2DS2-VASc for all-cause mortality in all cohorts. The GARFIELD-AF risk score was superior to CHA2DS2-VASc for non-haemorrhagic stroke, and it outperformed HAS-BLED for major bleeding in internal validation and in the Danish AF cohort. In very low- to low-risk patients [CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)], the GARFIELD-AF risk score offered strong discriminatory value for all the endpoints when compared to CHA2DS2-VASc and HAS-BLED. The GARFIELD-AF tool also included the effect of oral anticoagulation (OAC) therapy, thus allowing clinicians to compare the expected outcome of different anticoagulant treatment decisions [i.e. no OAC, non-vitamin K antagonist (VKA) oral anticoagulants, or VKAs]. Conclusions The GARFIELD-AF risk tool outperformed CHA2DS2-VASc at predicting death and non-haemorrhagic stroke, and it outperformed HAS-BLED for major bleeding in overall as well as in very low- to low-risk group patients with AF. Clinical trial registration URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF: NCT01090362, ORBIT-AF I: NCT01165710; ORBIT-AF II: NCT01701817.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| SWORD Depositor: | Library Publications Router | |||||||||
| Library of Congress Subject Headings (LCSH): | Atrial fibrillation -- Risk factors, Risk assessment, Cerebrovascular disease -- Risk factors | |||||||||
| Journal or Publication Title: | European Heart Journal - Quality of Care and Clinical Outcomes | |||||||||
| Publisher: | Oxford University Press | |||||||||
| ISSN: | 2058-5225 | |||||||||
| Official Date: | March 2022 | |||||||||
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| Volume: | 8 | |||||||||
| Number: | 2 | |||||||||
| Page Range: | pp. 214-227 | |||||||||
| DOI: | 10.1093/ehjqcco/qcab028 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access | |||||||||
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