Association between clinical risk scores and mortality in atrial fibrillation: Systematic review and network meta-regression of 669, 000 patients. (April 2020)

• Record Type: Journal Article
• Authors: Proietti, Marco; Farcomeni, Alessio; Romiti, Giulio Francesco; Di Rocco, Arianna; Placentino, Filippo; Diemberger, Igor; Lip, Gregory YH; Boriani, Giuseppe
• Is Part Of: European journal of preventive cardiology. Volume 27:Number 6(2020)
• Page Start: 633
• Page End: 644
• Publication Date: 2020-04
• Subjects: Atrial fibrillation -- mortality -- prognostic risk scores -- risk assessment -- outcomes; Cardiovascular system -- Diseases -- Prevention -- Periodicals; Cardiac patients -- Rehabilitation -- Periodicals; 616.12
• DOI: 10.1177/2047487318817662
• Languages: English
• ISSNs: 2047-4873

Abstract

Aims: 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. Methods: We performed a systematic search in PubMed and Scopus from inception to 22 July 2017. We considered the following scores: ATRIA-Stroke, ATRIA-Bleeding, CHADS2, CHA2 DS2 -VASc, HAS-BLED, HATCH and ORBIT. Papers reporting data about scores and all-cause death rates were considered. Results: Fifty studies and 71 scores groups were included in the analysis, with 669, 217 patients. Data on ATRIA-Bleeding, CHADS2, CHA2 DS2 -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) CHADS2 : 0.64 (0.63–0.65), CHA2 DS2 -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. CHA2 DS2 -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). Conclusion: 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 CHA2 DS2 -VASc score had consistently high negative predictive value during follow-up and the highest probability of being the best performing clinical score.