LVS-HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency Department [Elektronisk resurs] Data from a World-Wide Registry
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Johnson, Linda S. B. (författare)
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Oldgren, Jonas, 1964- (författare)
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Barrett, Tyler W. (författare)
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McNaughton, Candace D. (författare)
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Wong, Jorge A. (författare)
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McIntyre, William F. (författare)
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Freeman, Clifford L. (författare)
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Murphy, Laura (författare)
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Engström, Gunnar (författare)
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Ezekowitz, Michael (författare)
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Connolly, Stuart J. (författare)
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Xu, Lizhen (författare)
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Nakamya, Juliet (författare)
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Conen, David (författare)
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Bangdiwala, Shrikant (författare)
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Yusuf, Salim (författare)
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Healey, Jeff S. (författare)
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Uppsala universitet Medicinska och farmaceutiska vetenskapsområdet (utgivare)
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Uppsala universitet Medicinska och farmaceutiska vetenskapsområdet (utgivare)
- Publicerad: Ovid Technologies (Wolters Kluwer Health), 2021
- Engelska.
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Ingår i: Journal of the American Heart Association. - 2047-9980. ; 10:18
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Sammanfattning
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- 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.
Ämnesord
- Medical and Health Sciences (hsv)
- Clinical Medicine (hsv)
- Cardiac and Cardiovascular Systems (hsv)
- Medicin och hälsovetenskap (hsv)
- Klinisk medicin (hsv)
- Kardiologi (hsv)
Genre
- government publication (marcgt)
Indexterm och SAB-rubrik
- atrial fibrillation
- epidemiology
- heart failure
- prevention
- risk score
- risk stratification
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Journal of the American Heart Association