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Balancing risk and benefit in patients with atrial fibrillation: the GARFIELD-AF risk score

Session New approaches to risk prediction

Speaker Professor Keith Fox

Event : ESC Congress 2019

  • Topic : e-cardiology/digital health. public health. health economics. research methodology
  • Sub-topic : Biostatistics
  • Session type : Moderated Posters

Authors : K Fox (Edinburgh,GB), S Virdone (London,GB), K Pieper (London,GB)

K. Fox1 , S. Virdone2 , K. Pieper2 , 1University of Edinburgh - Edinburgh - United Kingdom , 2Thrombosis Research Institute - London - United Kingdom ,

On behalf: GARFIELD-AF Investigators


European Heart Journal ( 2019 ) 40 ( Supplement ), 3577

Background: The GARFIELD-AF risk tool was originally developed to predict future risk of adverse events in patients with atrial fibrillation (AF) using a range of baseline clinical variables. In the present work a new, improved risk tool was developed using data from all five GARFIELD cohorts gathered over 2 years' follow-up.

Purpose: To derive a new integrated risk tool for predicting mortality, stroke/systemic embolism (SE), and major bleeding in AF patients up to 2 years after enrolment and compare the risk tool versus CHA2DS2-VASc and HAS-BLED.

Methods: GARFIELD-AF is an international prospective registry of nonvalvular AF patients diagnosed within 6 weeks prior to enrolment and having at least one risk factor for stroke. In this study only the first occurrence of events was considered. Event rates were estimated using a Poisson model. Potential predictors of events including a large set of demographics, clinical characteristics, choice of treatment, and lifestyle factors were identified, and a Cox proportional hazards model chosen for each outcome by least absolute shrinkage and selection operator (LASSO). Indices were compared versus models of CHA2DS2-VASc and HAS-BLED.

Results: Among a total 52,080 patients enrolled 52,032 (male, 55.8%; median age, 71 years) had available follow-up data. At 2 years, 3702 patients had died (event rate, 3.82 [95% CI, 3.70–3.95] per 100 patient-years) whereas non-haemorrhagic stroke/SE was noted in 957 patients (rate, 1.00 [95% CI, 0.94–1.06] per 100 patient-years) and major bleed/haemorrhagic stroke in 673 patients (rate, 0.70 [95% CI, 0.65–0.75] per 100 patient-years). The GARFIELD risk tool outperformed CHA2DS2-VASc and HAS-BLED at predicting all adverse events in the overall population and pre-selected subpopulations over 2 years. Notably, the new model identified use of OAC therapy, which is not included in CHA2DS2-VASc, as one of the strongest predictors of risk of mortality and stroke, and unlike HAS-BLED, could discriminate a lower risk of bleeding in patients treated with NOACs versus VKAs.

Conclusions: The GARFIELD-AF risk tool demonstrated good calibration and discrimination, outperforming CHA2DS2-VASc at predicting risk of death and non-haemorrhagic stroke and HAS-BLED for major bleed in AF patients over 2 years.

PopulationAll-cause mortalityStroke/SEMajor bleeding*
Overall0.76 (0.75–0.76)0.66 (0.65–0.67)0.68 (0.67–0.70)0.64 (0.62–0.66)
AC treated0.74 (0.73–0.75)0.65 (0.64–0.66)0.68 (0.66–0.70)0.65 (0.62–0.67)0.67 (0.64–0.69)0.63 (0.61–0.65)
*Model only considers AC-treated patients.

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