A novel prognostic tool to predict mortality in patients with atrial fibrillation: The BASIC-AF risk score

Samaras, Athanasios; Κάρτας, Αναστάσιος; Akrivos, Evangelos; Fotos, G; Dividis, G; Vasdeki, Dimitra; Vrana, Eleni; Rampidis, Georgios; Karvounis, Haralambos; Giannakoulas, George

doi:10.1016/j.hjc.2021.01.007

Cited by 15 publications

(23 citation statements)

References 36 publications

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“…In this respect, it would be of interest to explore how novel echocardiographic biomarkers perform, especially left ventricular global longitudinal strain and myocardial work index. Ultimately, we feel that efforts for comprehensive risk assessment in AF using multiple‐biomarker based scores are in the right direction, as exemplified by the study of Hijazi et al 26 and a recent analysis from our cohort 27 …”

Section: Discussionmentioning

confidence: 90%

“…Ultimately, we feel that efforts for comprehensive risk assessment in AF using multiple-biomarker based scores are in the right direction, as exemplified by the study of Hijazi et al 26 and a recent analysis from our cohort. 27 Figure 3 Adjusted association between LVEF and outcomes. Spline curves of outcomes of AF-HF patients over a median 2 year follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Τhe association of heart failure across left ventricular ejection fraction with mortality in atrial fibrillation

et al. 2021

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Aims The aim of this study is to investigate the prognostic implications of the presence of heart failure (HF) across the range of left ventricular ejection fraction (LVEF) in patients with comorbid atrial fibrillation (AF). Methods and resultsWe conducted a retrospective cohort study of 1063 patients (median age 76 years), discharged from the cardiology ward with a primary or secondary diagnosis of AF between 2015 and 2018. We used Cox proportional-hazards and spline models to examine the association of the presence of HF, across the range of LVEF, with the primary outcome of all-cause mortality. HF was documented in 52.9% of patients at baseline. During a median follow-up of 31 months (interquartile range 10 to 52 months), 37.3% of patients died. The presence of HF was associated with a significantly higher risk of mortality [adjusted hazard ratio (aHR) 2.17; 95% confidence interval (CI), 1.70 to 2.77; P < 0.001], which was evident across HF with reduced (aHR 3.03; 95% CI 2.41 to 4.52), mid-range (aHR 2.08; 95% CI 1.47 to 2.94), and preserved LVEF (aHR 1.94; 95% CI 1.47 to 2.55). Among patients with HF, the spline curve depicted a non-linear association between LVEF and the risk of death, in which there was a steep and progressive increase in mortality for every 5% reduction in LVEF below 25% (aHR 1.97, 95% CI 1.04 to 3.73, P = 0.04). Conclusions In patients with AF who were discharged from the hospital, the presence of HF at baseline was independently associated with a twofold risk of death, which was significant across LVEF-classified HF subtypes. Among patients with AF and HF, the risk of death rose significantly as LVEF was reduced below 25%.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Τhe association of heart failure across left ventricular ejection fraction with mortality in atrial fibrillation

et al. 2021

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“…This discrepancy has three main etiologies; (1) the higher rate of comorbidities of our patient population, (2) the strict eligibility criteria of the RCTs compared with the MISOAC-AF trial, and (3) the varying definitions of sVHD across studies. Indeed, our study included only AF inpatients who were hospitalized for cardiac reasons [ 28 ], which is undoubtedly a relatively multimorbid group of patients. This is additionally confirmed by the higher age (median of 76 [ 14 ]) and CHA2DS2-VASc score (mean of 4.3) of our patients, compared to other AF registries.…”

Section: Discussionmentioning

confidence: 99%

Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation

Samaras

Vrana

Κάρτας

et al. 2021

BMC Cardiovasc Disord

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Background Valvular heart disease (VHD) in non-valvular atrial fibrillation (AF) is a puzzling clinical entity. The aim of this study was to evaluate the prognostic effect of significant VHD (sVHD) among patients with non-valvular AF. Methods This is a post-hoc analysis of the MISOAC-AF trial (NCT02941978). Consecutive inpatients with non-valvular AF who underwent echocardiography were included. sVHD was defined as the presence of at least moderate aortic stenosis (AS) or aortic/mitral/tricuspid regurgitation (AR/MR/TR). Cox regression analyses with covariate adjustments were used for outcome prediction. Results In total, 983 patients with non-valvular AF (median age 76 [14] years) were analyzed over a median follow-up period of 32 [20] months. sVHD was diagnosed in 575 (58.5%) AF patients. sVHD was associated with all-cause mortality (21.6%/yr vs. 6.5%/yr; adjusted HR [aHR] 1.55, 95% confidence interval [CI] 1.17–2.06; p = 0.02), cardiovascular mortality (16%/yr vs. 4%/yr; aHR 1.70, 95% CI 1.09–2.66; p = 0.02) and heart failure-hospitalization (5.8%/yr vs. 1.8%/yr; aHR 2.53, 95% CI 1.35–4.63; p = 0.02). The prognostic effect of sVHD was particularly evident in patients aged < 80 years and in those without history of heart failure (p for interaction < 0.05, in both subgroups). After multivariable adjustment, moderate/severe AS and TR were associated with mortality, while AS and MR with heart failure-hospitalization. Conclusion Among patients with non-valvular AF, sVHD was highly prevalent and beared high prognostic value across a wide spectrum of clinical outcomes, especially in patients aged < 80 years or in the absence of heart failure. Predominantly AS, as well as MR and TR, were associated with worse prognosis.

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“…This discrepancy has three main etiologies; (1) the higher rate of comorbidities of our patient population, (2) the strict eligibility criteria of the RCTs compared with the MISOAC-AF trial, and (3) the varying de nitions of sVHD across studies. Indeed, our study included only AF inpatients who were hospitalized for cardiac reasons, 27 which is undoubtedly a relatively multimorbid group of patients. This is additionally con rmed by the higher age (median of 76) and CHA2DS2-VASc score (mean of 4.4) of our patients, compared to other AF registries.…”

Section: Discussionmentioning

confidence: 99%

Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation

Samaras

Vrana

Κάρτας

et al. 2021

European Heart Journal

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Background Atrial fibrillation (AF) and valvular heart disease (VHD) are frequently encountered in clinical practice, and often coexist, especially in the elderly population. Both conditions are associated with increased mortality and morbidity. Recent guidelines suggest careful evaluation of patients with AF and VHD due to the puzzling nature of their coexistence. Purpose To evaluate the prognostic effect of significant valvular heart disease (sVHD) among patients with non-valvular AF. Methods This is a post-hoc analysis of the MISOAC-AF trial (NCT02941978). Consecutive inpatients with non-valvular AF who underwent echocardiography were included. sVHD was defined as the presence of at least moderate aortic stenosis (AS) or aortic/mitral/tricuspid regurgitation (AR/MR/TR). Cox regression analyses with covariate adjustments were used for outcome prediction. Results In total, 983 patients with non-valvular AF (median age 76 years) were analyzed over a median follow-up period of 32 months. sVHD was diagnosed in 575 (58.5%) AF patients. sVHD was associated with all-cause mortality (21.6%/yr vs. 1.6%/yr; adjusted HR [aHR] 1.55, 95% confidence interval [CI] 1.17–2.06; p=0.02), cardiovascular mortality (16%/yr vs. 4%/yr; aHR1.70, 95% CI 1.09–2.66; p=0.02) and heart failure-hospitalization (5.8%/yr vs. 1.8%/yr; aHR 2.53, 95% CI 1.35–4.63; p=0.02). The prognostic effect of sVHD was particularly evident in patients aged <80 years and in those without history of heart failure (p for interaction <0.05, in both subgroups) [Figure 1]. After multivariable adjustment, moderate/severe AS and TR were associated with mortality, while AS and MR with heart failure-hospitalization [Figure 2]. AS was the only independent predictor of valve intervention during follow-up (aHR 10.78, 95% CI 4.80–24.22; p<0.001). Mixed aortic valve disease (AS+AR) had superior prognostic power across patterns of combined VHD. Conclusions Among patients with non-valvular AF, sVHD was highly prevalent, and beared high prognostic value across a wide spectrum of clinical outcomes. AS, MR, TR and mixed aortic valve disease were associated with worse prognosis. FUNDunding Acknowledgement Type of funding sources: None. Subgroup analyses by VHD status Prognostic impact of valve lesions

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A novel prognostic tool to predict mortality in patients with atrial fibrillation: The BASIC-AF risk score

Cited by 15 publications

References 36 publications

Τhe association of heart failure across left ventricular ejection fraction with mortality in atrial fibrillation

Τhe association of heart failure across left ventricular ejection fraction with mortality in atrial fibrillation

Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation

Prognostic implications of valvular heart disease in patients with non-valvular atrial fibrillation

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