GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: a Danish nationwide validation study
Objectives To externally validate the accuracy of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) model against existing risk scores for stroke and major bleeding risk in patients with non-valvular AF in a population-based cohort.Design Retrospective cohort study.Set...
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BMJ Publishing Group
2019-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/11/e033283.full |
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| author | Christian Torp-Pedersen Keith AA Fox Ralf E Harskamp Karen Pieper Frederik Dalgaard Freek Verheugt A John Camm Ajay K Kakkar Jannik L Pallisgaard Peter V Rasmussen Henk van Weert Tommi Bo Lindhardt Gunnar H Gislason Martin H Ruwald |
| author_facet | Christian Torp-Pedersen Keith AA Fox Ralf E Harskamp Karen Pieper Frederik Dalgaard Freek Verheugt A John Camm Ajay K Kakkar Jannik L Pallisgaard Peter V Rasmussen Henk van Weert Tommi Bo Lindhardt Gunnar H Gislason Martin H Ruwald |
| author_sort | Christian Torp-Pedersen |
| collection | DOAJ |
| description | Objectives To externally validate the accuracy of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) model against existing risk scores for stroke and major bleeding risk in patients with non-valvular AF in a population-based cohort.Design Retrospective cohort study.Setting Danish nationwide registries.Participants 90 693 patients with newly diagnosed non-valvular AF were included between 2010 and 2016, with follow-up censored at 1 year.Primary and secondary outcome measures External validation was performed using discrimination and calibration plots. C-statistics were compared with CHA2DS2VASc score for ischaemic stroke/systemic embolism (SE) and HAS-BLED score for major bleeding/haemorrhagic stroke outcomes.Results Of the 90 693 included, 51 180 patients received oral anticoagulants (OAC). Overall median age (Q1, Q3) were 75 (66–83) years and 48 486 (53.5%) were male. At 1-year follow-up, a total of 2094 (2.3%) strokes/SE, 2642 (2.9%) major bleedings and 10 915 (12.0%) deaths occurred. The GARFIELD-AF model was well calibrated with the predicted risk for stroke/SE and major bleeding. The discriminatory value of GARFIELD-AF risk model was superior to CHA2DS2VASc for predicting stroke in the overall cohort (C-index: 0.71, 95% CI: 0.70 to 0.72 vs C-index: 0.67, 95% CI: 0.66 to 0.68, p<0.001) as well as in low-risk patients (C-index: 0.64, 95% CI: 0.59 to 0.69 vs C-index: 0.57, 95% CI: 0.53 to 0.61, p=0.007). The GARFIELD-AF model was comparable to HAS-BLED in predicting the risk of major bleeding in patients on OAC therapy (C-index: 0.64, 95% CI: 0.63 to 0.66 vs C-index: 0.64, 95% CI: 0.63 to 0.65, p=0.60).Conclusion In a nationwide Danish cohort with non-valvular AF, the GARFIELD-AF model adequately predicted the risk of ischaemic stroke/SE and major bleeding. Our external validation confirms that the GARFIELD-AF model was superior to CHA2DS2VASc in predicting stroke/SE and comparable with HAS-BLED for predicting major bleeding. |
| format | Article |
| id | doaj-art-efda6449e2cf49e1b565ce3d8fcc6cd8 |
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| language | English |
| publishDate | 2019-11-01 |
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| spelling | doaj-art-efda6449e2cf49e1b565ce3d8fcc6cd82025-08-20T02:07:23ZengBMJ Publishing GroupBMJ Open2044-60552019-11-0191110.1136/bmjopen-2019-033283GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: a Danish nationwide validation studyChristian Torp-Pedersen0Keith AA Fox1Ralf E Harskamp2Karen Pieper3Frederik Dalgaard4Freek Verheugt5A John Camm6Ajay K Kakkar7Jannik L Pallisgaard8Peter V Rasmussen9Henk van Weert10Tommi Bo Lindhardt11Gunnar H Gislason12Martin H Ruwald13Public Health, University of Copenhagen, Copenhagen, Denmark5 Department of Cardiology, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, UKDepartment of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC - University of Amsterdam, Amsterdam, The NetherlandsThrombosis Research Institute, London, UKDepartment of Cardiology, Herlev-Gentofte Hospital, Copenhagen, DenmarkCardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands5 Department of Cardiology, University of London St George`s Molecular and Clinical Sciences Research Institute, London, UKThrombosis Research Institute, London, UKresearch fellowDepartment of Neurology, Aarhus University Hospital, Aarhus, Denmark9 Department of General Practice, Amsterdam UMC, Amsterdam Public Health and Amsterdam Cardiovascular Sciences Research Institutes, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands1 Cardiology, Gentofte Hospital, Hellerup, Copenhagen, DenmarkDepartment of Cardiology, Copenhagen University Hospital, Kobenhavn, Denmark1 Cardiology, Gentofte Hospital, Hellerup, Copenhagen, DenmarkObjectives To externally validate the accuracy of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) model against existing risk scores for stroke and major bleeding risk in patients with non-valvular AF in a population-based cohort.Design Retrospective cohort study.Setting Danish nationwide registries.Participants 90 693 patients with newly diagnosed non-valvular AF were included between 2010 and 2016, with follow-up censored at 1 year.Primary and secondary outcome measures External validation was performed using discrimination and calibration plots. C-statistics were compared with CHA2DS2VASc score for ischaemic stroke/systemic embolism (SE) and HAS-BLED score for major bleeding/haemorrhagic stroke outcomes.Results Of the 90 693 included, 51 180 patients received oral anticoagulants (OAC). Overall median age (Q1, Q3) were 75 (66–83) years and 48 486 (53.5%) were male. At 1-year follow-up, a total of 2094 (2.3%) strokes/SE, 2642 (2.9%) major bleedings and 10 915 (12.0%) deaths occurred. The GARFIELD-AF model was well calibrated with the predicted risk for stroke/SE and major bleeding. The discriminatory value of GARFIELD-AF risk model was superior to CHA2DS2VASc for predicting stroke in the overall cohort (C-index: 0.71, 95% CI: 0.70 to 0.72 vs C-index: 0.67, 95% CI: 0.66 to 0.68, p<0.001) as well as in low-risk patients (C-index: 0.64, 95% CI: 0.59 to 0.69 vs C-index: 0.57, 95% CI: 0.53 to 0.61, p=0.007). The GARFIELD-AF model was comparable to HAS-BLED in predicting the risk of major bleeding in patients on OAC therapy (C-index: 0.64, 95% CI: 0.63 to 0.66 vs C-index: 0.64, 95% CI: 0.63 to 0.65, p=0.60).Conclusion In a nationwide Danish cohort with non-valvular AF, the GARFIELD-AF model adequately predicted the risk of ischaemic stroke/SE and major bleeding. Our external validation confirms that the GARFIELD-AF model was superior to CHA2DS2VASc in predicting stroke/SE and comparable with HAS-BLED for predicting major bleeding.https://bmjopen.bmj.com/content/9/11/e033283.full |
| spellingShingle | Christian Torp-Pedersen Keith AA Fox Ralf E Harskamp Karen Pieper Frederik Dalgaard Freek Verheugt A John Camm Ajay K Kakkar Jannik L Pallisgaard Peter V Rasmussen Henk van Weert Tommi Bo Lindhardt Gunnar H Gislason Martin H Ruwald GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: a Danish nationwide validation study BMJ Open |
| title | GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: a Danish nationwide validation study |
| title_full | GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: a Danish nationwide validation study |
| title_fullStr | GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: a Danish nationwide validation study |
| title_full_unstemmed | GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: a Danish nationwide validation study |
| title_short | GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: a Danish nationwide validation study |
| title_sort | garfield af model for prediction of stroke and major bleeding in atrial fibrillation a danish nationwide validation study |
| url | https://bmjopen.bmj.com/content/9/11/e033283.full |
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