LVS-HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency Department: Data from a World-Wide Registry.
LVS-HARMED Risk Score for Incident Heart Failure in Patients With Atrial Fibrillation Who Present to the Emergency Department: Data from a World-Wide Registry.
复制标题
DOI：
10.1161/jaha.120.017735
复制
发表时间：
2021-09-21
影响因子：
5.4
通讯作者：
Healey JS
中科院分区：
文献类型：
--
作者：
Johnson LSB;Oldgren J;Barrett TW;McNaughton CD;Wong JA;McIntyre WF;Freeman CL;Murphy L;Engström G;Ezekowitz M;Connolly SJ;Xu L;Nakamya J;Conen D;Bangdiwala SI;Yusuf S;Healey JS
心力衰竭（HF）是房颤（AF）的常见并发症，可导致再次住院和死亡。早期识别有HF风险的AF患者可能会改善结局。我们的目的是获得一个评分来预测AF急诊（艾德）就诊后1年新发HF的风险。RE‐LY AF（长期抗凝治疗的随机评价）登记研究招募了47个国家的艾德就诊的AF患者，并对他们进行了一年的随访。终点为HF住院和/或HF死亡。在15400例艾德患者中，9765例既往无HF（平均年龄，64.9±14.9岁）。1年内，6.8%的患者发生新发HF，其中21%死于HF。HF的独立预测因子包括左心室肥厚（比值比[OR]，1.47; 95% CI，1.19-1.82），心脏瓣膜病（OR，1.55; 95% CI，1.18-2.04），吸烟（OR，1.42; 95% CI，1.12-1.78），身高（OR，0.93; 95% CI，0.90-0.95/3 cm），年龄（OR，1.11; 95% CI，1.07-1.15/5年），风湿性心脏病（OR，1.77，95% CI，1.24-2.51），既往心肌梗死（OR，1.85; 95% CI，1.45-2.36），艾德出院时仍为AF（OR，1.86; 95% CI，1.46-2.36）和糖尿病（OR，1.33; 95% CI，1.09-1.64）。连续风险预测评分（LVS‐HARMED [左心室、心脏瓣膜病、吸烟或其他烟草使用、身高、年龄、风湿性心脏病、心肌梗死、急诊室出院节律和糖尿病]）具有良好的区分度（C统计量，0.735; 95% CI，0.716-0.755）。使用Bootstrapping（乐观校正C统计量，0.705）和外部（C统计量，0.699）进行内部验证。评分四分位数组的1年HF住院和/或HF死亡发生率分别为1.1%、4.5%、6.9%和14.4%。LVS‐HARMED还可预测卒中事件（C统计量，0.753; 95% CI，0.728-0.778）。LVS‐HARMED评分可预测因AF接受艾德访视后新发HF。对于LVS‐HARMED HF高风险患者，应考虑采取预防策略。
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. 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). 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.