GARFIELD-AF 评分用于预测房颤患者 2 年内的死亡、卒中和出血风险。

GARFIELD-AF risk score for mortality, stroke, and bleeding within 2 years in patients with atrial fibrillation.

机构信息

Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.

Thrombosis Research Institute, Manresa Road, London, SW3 6LR, UK.

出版信息

Eur Heart J Qual Care Clin Outcomes. 2022 Mar 2;8(2):214-227. doi: 10.1093/ehjqcco/qcab028.

AIMS

To determine whether the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) integrated risk tool predicts mortality, non-haemorrhagic stroke/systemic embolism, and major bleeding for up to 2 years after new-onset AF and to assess how this risk tool performs compared with CHA2DS2-VASc and HAS-BLED.

METHODS AND RESULTS

Potential predictors of events included demographic and clinical characteristics, choice of treatment, and lifestyle factors. A Cox proportional hazards model was identified for each outcome by least absolute shrinkage and selection operator methods. Indices were evaluated in comparison with CHA2DS2-VASc and HAS-BLED risk predictors. Models were validated internally and externally in ORBIT-AF and Danish nationwide registries. Among the 52 080 patients enrolled in GARFIELD-AF, 52 032 had follow-up data. The GARFIELD-AF risk tool outperformed CHA2DS2-VASc for all-cause mortality in all cohorts. The GARFIELD-AF risk score was superior to CHA2DS2-VASc for non-haemorrhagic stroke, and it outperformed HAS-BLED for major bleeding in internal validation and in the Danish AF cohort. In very low- to low-risk patients [CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)], the GARFIELD-AF risk score offered strong discriminatory value for all the endpoints when compared to CHA2DS2-VASc and HAS-BLED. The GARFIELD-AF tool also included the effect of oral anticoagulation (OAC) therapy, thus allowing clinicians to compare the expected outcome of different anticoagulant treatment decisions [i.e. no OAC, non-vitamin K antagonist (VKA) oral anticoagulants, or VKAs].

CONCLUSIONS

The GARFIELD-AF risk tool outperformed CHA2DS2-VASc at predicting death and non-haemorrhagic stroke, and it outperformed HAS-BLED for major bleeding in overall as well as in very low- to low-risk group patients with AF.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF: NCT01090362, ORBIT-AF I: NCT01165710; ORBIT-AF II: NCT01701817.

目的

确定新发性心房颤动（AF）后 2 年内，全球抗凝剂注册在 FIELD-AF（GARFIELD-AF）综合风险工具是否能预测死亡率、非出血性卒中和全身性栓塞以及大出血，并评估该风险工具与 CHA2DS2-VASc 和 HAS-BLED 相比表现如何。

方法和结果

事件的潜在预测因子包括人口统计学和临床特征、治疗选择和生活方式因素。通过最小绝对收缩和选择算子方法为每种结局确定 Cox 比例风险模型。通过与 CHA2DS2-VASc 和 HAS-BLED 风险预测因子比较，评估指数。在 ORBIT-AF 和丹麦全国登记处内部和外部验证模型。在 GARFIELD-AF 中登记的 52080 名患者中，52032 名患者有随访数据。在所有队列中，GARFIELD-AF 风险工具在全因死亡率方面均优于 CHA2DS2-VASc。在非出血性卒中和大出血方面，GARFIELD-AF 风险评分优于 CHA2DS2-VASc，在内部验证和丹麦 AF 队列中，优于 HAS-BLED。在极低至低风险患者[CHA2DS2-VASc 0 或 1（男性）和 1 或 2（女性）]中，与 CHA2DS2-VASc 和 HAS-BLED 相比，GARFIELD-AF 风险评分在所有终点均具有很强的判别能力。GARFIELD-AF 工具还包括口服抗凝剂（OAC）治疗的效果，因此允许临床医生比较不同抗凝治疗决策的预期结果[即无 OAC、非维生素 K 拮抗剂（VKA）口服抗凝剂或 VKA]。