Improving CHA2DS2-VASc stratification of non-fatal stroke and mortality risk using the Intermountain Mortality Risk Score among patients with atrial fibrillation
BackgroundOral anticoagulation (OAC) therapy guidelines recommend using CHA2DS2-VASc to determine OAC need in atrial fibrillation (AF). A usable tool, CHA2DS2-VASc is challenged by its predictive ability. Applying components of the complete blood count and basic metabolic profile, the Intermountain...
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| Veröffentlicht in: | Open heart 2018-01, Vol.5 (2), p.e000907-e000907 |
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| creator | Graves, Kevin G May, Heidi T Knowlton, Kirk U Muhlestein, Joseph B Jacobs, Victoria Lappé, Donald L Anderson, Jeffrey L Horne, Benjamin D Bunch, Thomas Jared |
| description | BackgroundOral anticoagulation (OAC) therapy guidelines recommend using CHA2DS2-VASc to determine OAC need in atrial fibrillation (AF). A usable tool, CHA2DS2-VASc is challenged by its predictive ability. Applying components of the complete blood count and basic metabolic profile, the Intermountain Mortality Risk Score (IMRS) has been extensively validated. This study evaluated whether use of IMRS with CHA2DS2-VASc in patients with AF improves prediction.MethodsPatients with AF undergoing cardiac catheterisation (N=10 077) were followed for non-fatal stroke and mortality (mean 5.8±4.1 years, maximum 19 years). CHA2DS2-VASc and IMRS were calculated at baseline. IMRS categories were defined based on previously defined criteria. Cox regression was adjusted for demographic, clinical and treatment variables not included in IMRS or CHA2DS2-VASc.ResultsIn women (n=4122, mean age 71±12 years), the composite of non-fatal stroke/mortality was stratified (all p-trend 2: 48.1%) and IMRS (low: 17.8%, moderate: 40.9%, high risk: 64.5%), as it was for men (n=5955, mean age 68±12 years) by CHA2DS2-VASc (2: 51.8%) and IMRS (low: 19.0%, moderate: 42.0%, high risk: 65.9%). IMRS stratified stroke/mortality (all p-trend |
| doi_str_mv | 10.1136/openhrt-2018-000907 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6269639</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2158555600</sourcerecordid><originalsourceid>FETCH-LOGICAL-b285t-41ae80212b622ae61ab57ff6f2d726c0fea5212eb93b2bb4b39a99a0be7456773</originalsourceid><addsrcrecordid>eNpdks2OFCEUhYnROJNxnsANiRs3jPwUVLEx6bQ_08kYE1uNOwLVME1PFZRAjZnH8U2l7M4kugHC_Tjn3nAAeEnwFSFMvImTDftUEMWkQxhjidsn4JxizhATtHlaz0x2iEv-4wxc5nyoDKFcYCmegzOGuWhYy8_B7804pXjvwy1cX6_ouy1F31fbHuaSdPHO93WNAUYHQwzI6aKHpRbvLNRhB8eY6o0vDzD5fAfnvAiVvYWbUGwa4xyK9gF-esS-LNi2j6m-H2OFp2pgQ8nwly97qEvy1cF5k_ww_PV-AZ45PWR7edovwLcP77-ur9HN54-b9eoGGdrxghqibYcpoUZQqq0g2vDWOeHorqWix85qXqvWSGaoMY1hUkupsbFtw0Xbsgvw9qg7zWa0u742lfSgpuRHnR5U1F79Wwl-r27jvRJUSMFkFXh9Ekjx52xzUaPPva1jBBvnrCjhHef1C3BFX_2HHuKcQh2vUkxiInDHK3V1pMx4eOyDYLUEQJ0CoJYAqGMA2B8snKeb</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2139016085</pqid></control><display><type>article</type><title>Improving CHA2DS2-VASc stratification of non-fatal stroke and mortality risk using the Intermountain Mortality Risk Score among patients with atrial fibrillation</title><source>BMJ Open Access Journals</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Free E- Journals</source><creator>Graves, Kevin G ; May, Heidi T ; Knowlton, Kirk U ; Muhlestein, Joseph B ; Jacobs, Victoria ; Lappé, Donald L ; Anderson, Jeffrey L ; Horne, Benjamin D ; Bunch, Thomas Jared</creator><creatorcontrib>Graves, Kevin G ; May, Heidi T ; Knowlton, Kirk U ; Muhlestein, Joseph B ; Jacobs, Victoria ; Lappé, Donald L ; Anderson, Jeffrey L ; Horne, Benjamin D ; Bunch, Thomas Jared</creatorcontrib><description>BackgroundOral anticoagulation (OAC) therapy guidelines recommend using CHA2DS2-VASc to determine OAC need in atrial fibrillation (AF). A usable tool, CHA2DS2-VASc is challenged by its predictive ability. Applying components of the complete blood count and basic metabolic profile, the Intermountain Mortality Risk Score (IMRS) has been extensively validated. This study evaluated whether use of IMRS with CHA2DS2-VASc in patients with AF improves prediction.MethodsPatients with AF undergoing cardiac catheterisation (N=10 077) were followed for non-fatal stroke and mortality (mean 5.8±4.1 years, maximum 19 years). CHA2DS2-VASc and IMRS were calculated at baseline. IMRS categories were defined based on previously defined criteria. Cox regression was adjusted for demographic, clinical and treatment variables not included in IMRS or CHA2DS2-VASc.ResultsIn women (n=4122, mean age 71±12 years), the composite of non-fatal stroke/mortality was stratified (all p-trend <0.001) by CHA2DS2-VASc (1: 12.6%, 2: 22.8%, >2: 48.1%) and IMRS (low: 17.8%, moderate: 40.9%, high risk: 64.5%), as it was for men (n=5955, mean age 68±12 years) by CHA2DS2-VASc (<2: 15.7%, 2: 30.3%, >2: 51.8%) and IMRS (low: 19.0%, moderate: 42.0%, high risk: 65.9%). IMRS stratified stroke/mortality (all p-trend <0.001) in each CHA2DS2-VASc category.ConclusionsUsing IMRS jointly with CHA2DS2-VASc in patients with AF improved the prediction of stroke and mortality. For example, in patients at the OAC treatment threshold (CHA2DS2 -VASc = 2), IMRS provided ≈4-fold separation between low and high risk. IMRS provides an enhancing marker for risk in patients with AF that reflects the underlying systemic nature of this disease that may be considered in combination with the CHA2DS2-VASc score.</description><identifier>ISSN: 2398-595X</identifier><identifier>ISSN: 2053-3624</identifier><identifier>EISSN: 2053-3624</identifier><identifier>DOI: 10.1136/openhrt-2018-000907</identifier><identifier>PMID: 30564375</identifier><language>eng</language><publisher>London: BMJ Publishing Group LTD</publisher><subject>Anticoagulants ; Arrhythmias and Sudden Death ; Blood platelets ; Blood tests ; Cardiac arrhythmia ; Cardiovascular disease ; Clinical medicine ; Health risk assessment ; Heart ; Hematology ; Mortality ; Stroke ; Studies ; Systematic review ; Thromboembolism</subject><ispartof>Open heart, 2018-01, Vol.5 (2), p.e000907-e000907</ispartof><rights>Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2018 Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0 Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-b285t-41ae80212b622ae61ab57ff6f2d726c0fea5212eb93b2bb4b39a99a0be7456773</cites><orcidid>0000-0002-2656-0263 ; 0000-0001-5349-0136</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://openheart.bmj.com/content/5/2/e000907.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://openheart.bmj.com/content/5/2/e000907.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27549,27550,27924,27925,53791,53793,77601,77632</link.rule.ids></links><search><creatorcontrib>Graves, Kevin G</creatorcontrib><creatorcontrib>May, Heidi T</creatorcontrib><creatorcontrib>Knowlton, Kirk U</creatorcontrib><creatorcontrib>Muhlestein, Joseph B</creatorcontrib><creatorcontrib>Jacobs, Victoria</creatorcontrib><creatorcontrib>Lappé, Donald L</creatorcontrib><creatorcontrib>Anderson, Jeffrey L</creatorcontrib><creatorcontrib>Horne, Benjamin D</creatorcontrib><creatorcontrib>Bunch, Thomas Jared</creatorcontrib><title>Improving CHA2DS2-VASc stratification of non-fatal stroke and mortality risk using the Intermountain Mortality Risk Score among patients with atrial fibrillation</title><title>Open heart</title><description>BackgroundOral anticoagulation (OAC) therapy guidelines recommend using CHA2DS2-VASc to determine OAC need in atrial fibrillation (AF). A usable tool, CHA2DS2-VASc is challenged by its predictive ability. Applying components of the complete blood count and basic metabolic profile, the Intermountain Mortality Risk Score (IMRS) has been extensively validated. This study evaluated whether use of IMRS with CHA2DS2-VASc in patients with AF improves prediction.MethodsPatients with AF undergoing cardiac catheterisation (N=10 077) were followed for non-fatal stroke and mortality (mean 5.8±4.1 years, maximum 19 years). CHA2DS2-VASc and IMRS were calculated at baseline. IMRS categories were defined based on previously defined criteria. Cox regression was adjusted for demographic, clinical and treatment variables not included in IMRS or CHA2DS2-VASc.ResultsIn women (n=4122, mean age 71±12 years), the composite of non-fatal stroke/mortality was stratified (all p-trend <0.001) by CHA2DS2-VASc (1: 12.6%, 2: 22.8%, >2: 48.1%) and IMRS (low: 17.8%, moderate: 40.9%, high risk: 64.5%), as it was for men (n=5955, mean age 68±12 years) by CHA2DS2-VASc (<2: 15.7%, 2: 30.3%, >2: 51.8%) and IMRS (low: 19.0%, moderate: 42.0%, high risk: 65.9%). IMRS stratified stroke/mortality (all p-trend <0.001) in each CHA2DS2-VASc category.ConclusionsUsing IMRS jointly with CHA2DS2-VASc in patients with AF improved the prediction of stroke and mortality. For example, in patients at the OAC treatment threshold (CHA2DS2 -VASc = 2), IMRS provided ≈4-fold separation between low and high risk. IMRS provides an enhancing marker for risk in patients with AF that reflects the underlying systemic nature of this disease that may be considered in combination with the CHA2DS2-VASc score.</description><subject>Anticoagulants</subject><subject>Arrhythmias and Sudden Death</subject><subject>Blood platelets</subject><subject>Blood tests</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular disease</subject><subject>Clinical medicine</subject><subject>Health risk assessment</subject><subject>Heart</subject><subject>Hematology</subject><subject>Mortality</subject><subject>Stroke</subject><subject>Studies</subject><subject>Systematic review</subject><subject>Thromboembolism</subject><issn>2398-595X</issn><issn>2053-3624</issn><issn>2053-3624</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdks2OFCEUhYnROJNxnsANiRs3jPwUVLEx6bQ_08kYE1uNOwLVME1PFZRAjZnH8U2l7M4kugHC_Tjn3nAAeEnwFSFMvImTDftUEMWkQxhjidsn4JxizhATtHlaz0x2iEv-4wxc5nyoDKFcYCmegzOGuWhYy8_B7804pXjvwy1cX6_ouy1F31fbHuaSdPHO93WNAUYHQwzI6aKHpRbvLNRhB8eY6o0vDzD5fAfnvAiVvYWbUGwa4xyK9gF-esS-LNi2j6m-H2OFp2pgQ8nwly97qEvy1cF5k_ww_PV-AZ45PWR7edovwLcP77-ur9HN54-b9eoGGdrxghqibYcpoUZQqq0g2vDWOeHorqWix85qXqvWSGaoMY1hUkupsbFtw0Xbsgvw9qg7zWa0u742lfSgpuRHnR5U1F79Wwl-r27jvRJUSMFkFXh9Ekjx52xzUaPPva1jBBvnrCjhHef1C3BFX_2HHuKcQh2vUkxiInDHK3V1pMx4eOyDYLUEQJ0CoJYAqGMA2B8snKeb</recordid><startdate>20180101</startdate><enddate>20180101</enddate><creator>Graves, Kevin G</creator><creator>May, Heidi T</creator><creator>Knowlton, Kirk U</creator><creator>Muhlestein, Joseph B</creator><creator>Jacobs, Victoria</creator><creator>Lappé, Donald L</creator><creator>Anderson, Jeffrey L</creator><creator>Horne, Benjamin D</creator><creator>Bunch, Thomas Jared</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2656-0263</orcidid><orcidid>https://orcid.org/0000-0001-5349-0136</orcidid></search><sort><creationdate>20180101</creationdate><title>Improving CHA2DS2-VASc stratification of non-fatal stroke and mortality risk using the Intermountain Mortality Risk Score among patients with atrial fibrillation</title><author>Graves, Kevin G ; May, Heidi T ; Knowlton, Kirk U ; Muhlestein, Joseph B ; Jacobs, Victoria ; Lappé, Donald L ; Anderson, Jeffrey L ; Horne, Benjamin D ; Bunch, Thomas Jared</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b285t-41ae80212b622ae61ab57ff6f2d726c0fea5212eb93b2bb4b39a99a0be7456773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Anticoagulants</topic><topic>Arrhythmias and Sudden Death</topic><topic>Blood platelets</topic><topic>Blood tests</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular disease</topic><topic>Clinical medicine</topic><topic>Health risk assessment</topic><topic>Heart</topic><topic>Hematology</topic><topic>Mortality</topic><topic>Stroke</topic><topic>Studies</topic><topic>Systematic review</topic><topic>Thromboembolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Graves, Kevin G</creatorcontrib><creatorcontrib>May, Heidi T</creatorcontrib><creatorcontrib>Knowlton, Kirk U</creatorcontrib><creatorcontrib>Muhlestein, Joseph B</creatorcontrib><creatorcontrib>Jacobs, Victoria</creatorcontrib><creatorcontrib>Lappé, Donald L</creatorcontrib><creatorcontrib>Anderson, Jeffrey L</creatorcontrib><creatorcontrib>Horne, Benjamin D</creatorcontrib><creatorcontrib>Bunch, Thomas Jared</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Open heart</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Graves, Kevin G</au><au>May, Heidi T</au><au>Knowlton, Kirk U</au><au>Muhlestein, Joseph B</au><au>Jacobs, Victoria</au><au>Lappé, Donald L</au><au>Anderson, Jeffrey L</au><au>Horne, Benjamin D</au><au>Bunch, Thomas Jared</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improving CHA2DS2-VASc stratification of non-fatal stroke and mortality risk using the Intermountain Mortality Risk Score among patients with atrial fibrillation</atitle><jtitle>Open heart</jtitle><date>2018-01-01</date><risdate>2018</risdate><volume>5</volume><issue>2</issue><spage>e000907</spage><epage>e000907</epage><pages>e000907-e000907</pages><issn>2398-595X</issn><issn>2053-3624</issn><eissn>2053-3624</eissn><abstract>BackgroundOral anticoagulation (OAC) therapy guidelines recommend using CHA2DS2-VASc to determine OAC need in atrial fibrillation (AF). A usable tool, CHA2DS2-VASc is challenged by its predictive ability. Applying components of the complete blood count and basic metabolic profile, the Intermountain Mortality Risk Score (IMRS) has been extensively validated. This study evaluated whether use of IMRS with CHA2DS2-VASc in patients with AF improves prediction.MethodsPatients with AF undergoing cardiac catheterisation (N=10 077) were followed for non-fatal stroke and mortality (mean 5.8±4.1 years, maximum 19 years). CHA2DS2-VASc and IMRS were calculated at baseline. IMRS categories were defined based on previously defined criteria. Cox regression was adjusted for demographic, clinical and treatment variables not included in IMRS or CHA2DS2-VASc.ResultsIn women (n=4122, mean age 71±12 years), the composite of non-fatal stroke/mortality was stratified (all p-trend <0.001) by CHA2DS2-VASc (1: 12.6%, 2: 22.8%, >2: 48.1%) and IMRS (low: 17.8%, moderate: 40.9%, high risk: 64.5%), as it was for men (n=5955, mean age 68±12 years) by CHA2DS2-VASc (<2: 15.7%, 2: 30.3%, >2: 51.8%) and IMRS (low: 19.0%, moderate: 42.0%, high risk: 65.9%). IMRS stratified stroke/mortality (all p-trend <0.001) in each CHA2DS2-VASc category.ConclusionsUsing IMRS jointly with CHA2DS2-VASc in patients with AF improved the prediction of stroke and mortality. For example, in patients at the OAC treatment threshold (CHA2DS2 -VASc = 2), IMRS provided ≈4-fold separation between low and high risk. IMRS provides an enhancing marker for risk in patients with AF that reflects the underlying systemic nature of this disease that may be considered in combination with the CHA2DS2-VASc score.</abstract><cop>London</cop><pub>BMJ Publishing Group LTD</pub><pmid>30564375</pmid><doi>10.1136/openhrt-2018-000907</doi><orcidid>https://orcid.org/0000-0002-2656-0263</orcidid><orcidid>https://orcid.org/0000-0001-5349-0136</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Anticoagulants Arrhythmias and Sudden Death Blood platelets Blood tests Cardiac arrhythmia Cardiovascular disease Clinical medicine Health risk assessment Heart Hematology Mortality Stroke Studies Systematic review Thromboembolism |
| title | Improving CHA2DS2-VASc stratification of non-fatal stroke and mortality risk using the Intermountain Mortality Risk Score among patients with atrial fibrillation |
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