New analyses from the Global Anticoagulant Registry in the FIELD – Atrial Fibrillation (GARFIELD-AF) show that a novel computer-generated machine learning risk model – the GARFIELD-AF Score – is superior to CHA2DS2-VASc in predicting all-cause mortality, ischaemic stroke/systemic embolism (SE) and major bleeding in low-risk patients.
A simplified GARFIELD-AF Score, potentially suitable for web applications, has been developed and its performance assessed using an independent contemporary registry from the USA, ORBIT-AF.
New analyses from the Global Anticoagulant Registry in the FIELD – Atrial Fibrillation (GARFIELD-AF) show that a novel computer-generated machine learning risk model – the GARFIELD-AF Score – is superior to CHA2DS2-VASc in predicting all-cause mortality, ischaemic stroke/systemic embolism (SE) and major bleeding in low-risk patients.
A simplified GARFIELD-AF Score, potentially suitable for web applications, has been developed and its performance assessed using an independent contemporary registry from the USA, ORBIT-AF.
The GARFIELD-AF Score was developed after contemporary data from the GARFIELD-AF Registry revealed that approximately half of low-risk patients are receiving anticoagulation treatment.1 “These data show that factors beyond those in current risk scores appear to be influencing prescribing decisions on anticoagulation and improved risk stratification tools are needed to better identify truly low-risk AF patients,” said Professor Keith A A Fox, Duke of Edinburgh Professor of Cardiology at the University of Edinburgh, UK.
“The more comprehensive GARFIELD-AF Score includes multiple variables, beyond that of CHA2DS2-VASc, and this increased granularity will help to optimise the management of low-risk patients. The GARFIELD-AF Score has the potential to be incorporated into routine electronic record systems via web-based or mobile device applications, thereby enabling users to base treatment decisions on more precise and tailored values, as well as more complete estimates of risk based on multiple outcomes,” said Professor Fox.
The GARFIELD-AF Score is based on the analyses of data from 38,984 patients, enrolled in GARFIELD-AF between March 2010 and July 2015. In low-risk patients, the GARFIELD-AF Score offered superior discriminatory value in predicting all-cause mortality, ischaemic stroke/SE or haemorrhagic stroke/major bleed with C statistics* of: 0.72, 0.62 and 0.72, respectively, compared with CHA2DS2-VASc which had C statistics of: 0.56, 0.56 and 0.57, respectively for each endpoint.
Global shift in AF management
Further insights from GARFIELD-AF showed a shift in how AF is being managed across the globe. The number of patients receiving anticoagulant treatment for stroke prevention has increased substantially from 57% to 71% between March 2010 and August 2015. This shift in anticoagulant management of patients with AF is largely due to the marked increase in non-vitamin K antagonist oral anticoagulants (NOACs) with or without an antiplatelet prescribing from 4.1% to 37.0%, with a corresponding fall in vitamin K antagonists (VKAs) and antiplatelet (combined or alone) use from 83.4% to 50.6%.1
“The change in treatment patterns over the past 5 years suggests a greater clinical emphasis on stroke prevention,” said Professor Ajay Kakkar, Professor of Surgery at University College London and Director of the Thrombosis Research Institute, UK. “The challenge remains ensuring the appropriate patient receives the most effective and safe intervention to secure the best clinical outcome.”
Comorbidities and integrated care
New data, showcased during the GARFIELD-AF Satellite Symposium at ESC Congress 2016, revealed that mortality rates are higher during the first month after diagnosis of AF than at any other time over the subsequent 2-year follow-up. The risk of early death is greater in patients with prior history of myocardial infarction/unstable angina, moderate-to-severe chronic kidney disease, or stroke than in those without these comorbidities.
“These data from the GARFIELD-AF registry indicate the importance of comorbidities in predicting the risk of early mortality in patients with AF,” said Professor Samuel Goldhaber of Harvard Medical School and the Brigham and Women’s Hospital, USA. “The results suggest the importance of an integrated care approach for managing these patients.”
Reference
- Camm AJ, Accetta G, Ambrosio G, et al. Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation. Heart 2016; doi: 10.1136/heartjnl-2016-309832.
