Association between clinical risk scores and mortality in atrial fibrillation: Systematic review and network meta-regression of 669,000 patients.
EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY(2020)
摘要
Aims Many clinical scores for risk stratification in patients with atrial fibrillation have been proposed, and some have been useful in predicting all-cause mortality. We aim to analyse the relationship between clinical risk score and all-cause death occurrence in atrial fibrillation patients. Methods We performed a systematic search in PubMed and Scopus from inception to 22 July 2017. We considered the following scores: ATRIA-Stroke, ATRIA-Bleeding, CHADS(2), CHA(2)DS(2)-VASc, HAS-BLED, HATCH and ORBIT. Papers reporting data about scores and all-cause death rates were considered. Results Fifty studies and 71 scores groups were included in the analysis, with 669,217 patients. Data on ATRIA-Bleeding, CHADS(2), CHA(2)DS(2)-VASc and HAS-BLED were available. All the scores were significantly associated with an increased risk for all-cause death. All the scores showed modest predictive ability at five years (c-indexes (95% confidence interval) CHADS(2): 0.64 (0.63-0.65), CHA(2)DS(2)-VASc: 0.62 (0.61-0.64), HAS-BLED: 0.62 (0.58-0.66)). Network meta-regression found no significant differences in predictive ability. CHA(2)DS(2)-VASc score had consistently high negative predictive value (>= 94%) at one, three and five years of follow-up; conversely it showed the highest probability of being the best performing score (63% at one year, 60% at three years, 68% at five years). Conclusion In atrial fibrillation patients, contemporary clinical risk scores are associated with an increased risk of all-cause death. Use of these scores for death prediction in atrial fibrillation patients could be considered as part of holistic clinical assessment. The CHA(2)DS(2)-VASc score had consistently high negative predictive value during follow-up and the highest probability of being the best performing clinical score.
更多查看译文
关键词
Atrial fibrillation,mortality,prognostic risk scores,risk assessment,outcomes
AI 理解论文
溯源树
样例
生成溯源树,研究论文发展脉络
Chat Paper
正在生成论文摘要