Improving CHA2DS2-VASc stratification of non-fatal stroke and mortality risk using the Intermountain Mortality Risk Score among patients with atrial fibrillation. Issue 2 (17th November 2018)

• Record Type: Journal Article
• Authors: Graves, Kevin G; May, Heidi T; Knowlton, Kirk U; Muhlestein, Joseph B; Jacobs, Victoria; Lappé, Donald L; Anderson, Jeffrey L; Horne, Benjamin D; Bunch, Thomas Jared
• Is Part Of: Open heart. Volume 5:Issue 2(2018)
• Publication Date: 2018-11-17
• Subjects: atrial fibrillation -- stroke -- risk factors -- mortality -- gender; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Patients -- Periodicals; 616.12005
• DOI: 10.1136/openhrt-2018-000907
• Languages: English
• ISSNs: 2398-595X

Abstract

Abstract : Background: Oral anticoagulation (OAC) therapy guidelines recommend using CHA2 DS2 -VASc to determine OAC need in atrial fibrillation (AF). A usable tool, CHA2 DS2 -VASc is challenged by its predictive ability. Applying components of the complete blood count and basic metabolic profile, the Intermountain Mortality Risk Score (IMRS) has been extensively validated. This study evaluated whether use of IMRS with CHA2 DS2 -VASc in patients with AF improves prediction. Methods: Patients with AF undergoing cardiac catheterisation (N=10 077) were followed for non-fatal stroke and mortality (mean 5.8±4.1 years, maximum 19 years). CHA2 DS2 -VASc and IMRS were calculated at baseline. IMRS categories were defined based on previously defined criteria. Cox regression was adjusted for demographic, clinical and treatment variables not included in IMRS or CHA2 DS2 -VASc. Results: In women (n=4122, mean age 71±12 years), the composite of non-fatal stroke/mortality was stratified (all p-trend <0.001) by CHA2 DS2 -VASc (1: 12.6%, 2: 22.8%, >2: 48.1%) and IMRS (low: 17.8%, moderate: 40.9%, high risk: 64.5%), as it was for men (n=5955, mean age 68±12 years) by CHA2 DS2 -VASc (<2: 15.7%, 2: 30.3%, >2: 51.8%) and IMRS (low: 19.0%, moderate: 42.0%, high risk: 65.9%). IMRS stratified stroke/mortality (all p-trend <0.001) in each CHA2 DS2 -VASc category. Conclusions: Using IMRS jointly with CHA2 DS2 -VASc in patients with AF improved the prediction of stroke and mortality. For example, in patients at the OAC treatment threshold (CHA2 DS2 -VASc = 2), IMRS provided ≈4-fold separation between low and high risk. IMRS provides an enhancing marker for risk in patients with AF that reflects the underlying systemic nature of this disease that may be considered in combination with the CHA2 DS2 -VASc score.