Arrhythmias and conduction disturbances
A New Scoring System for Evaluating the Risk of Heart Failure Events in Japanese Patients With Atrial Fibrillation

https://doi.org/10.1016/j.amjcard.2012.04.049Get rights and content

Risk stratification for heart failure (HF) in patients with atrial fibrillation (AF) has not been well established. The aim of this study was to identify the predictors of HF events in patients with AF, consequently developing a new risk-scoring system that stratifies the risk for HF events. In this prospective, single hospital-based cohort, all patients who presented from July 2004 to March 2010 were registered (Shinken Database 2004–2009). Follow-up was maintained by being linked to the medical records or by sending study documents of prognosis. Of the 13,228 patients in the Shinken Database 2004–2009, 1,942 patients with AF were identified. Of the patients with AF, HF events (hospitalization or death from HF) occurred in 147 patients (7.6%) during a mean follow-up period of 776 ± 623 days. After identifying the parameters that were independently associated with the incidence of HF events (coexistence of organic heart diseases, anemia [hemoglobin level <11 g/dl], renal dysfunction [estimated glomerular filtration rate <60 ml/min/m2], diabetes mellitus, and the use of diuretics), a new scoring system was developed, the H2ARDD score (heart diseases = 2 points, anemia = 1 point, renal dysfunction = 1 point, diabetes = 1 point, and diuretic use = 1 point; range 0 to 6 points). This scoring system discriminated the low- and high-risk populations well (incidence in patients scoring 0 and 6 points of 0.2% and 40.8% per patient-year, respectively) and showed high predictive ability (area under the curve 0.840, 95% confidence interval 0.803 to 0.876). In conclusion, the new H2ARDD score may help identify the population of patients with AF at high risk for HF events.

Section snippets

Methods

The Shinken Database was established for all new patients who visited The Cardiovascular Institute in Tokyo, Japan (Shinken is an abbreviated name in Japanese for the name of the hospital), and it excluded patients with active cancer and foreign travelers. The principal aim of this hospital-based database is to survey the prevalence and prognosis of cardiovascular diseases in patients in urban areas of Japan.5, 6 The registry was started in June 2004, and thereafter, patients have been

Results

The characteristics of the study patients (with AF; n = 1,942) are listed in Table 1. Patients with AF in the present study included 1,426 men (73%) and had a mean age of 66 years. Coexisting organic heart diseases were observed in approximately 1/3 of the patients with AF, and symptomatic HF was observed in approximately 20%.

During the average follow-up period of 776 ± 623 days, hospitalization or death with HF occurred in 147 patients (7.6%); 14 patients (0.7%) died from HF. The cumulative

Discussion

In the present study with Japanese patients with AF, we determined the cumulative incidence rates of HF events (hospitalization or death with HF). We also identified the independent predictors for HF events, consequently developing a new risk score, the H2ARDD score. The H2ARDD score stratified the risk for the incidence of HF events well, with a high predictive ability. The new risk score might aid in the identification of patients with AF at risk for the incidence of new hospitalization or

Acknowledgment

We thank Shiro Ueda and Nobuko Ueda at Medical Edge Company, Ltd., for assembling the database by the Clinical Study Supporting System and Ineko Hayakawa, Hiroaki Arai, and Hirokazu Aoki for data management and systems administration.

References (29)

  • S. Rubler et al.

    New type of cardiomyopathy associated with diabetic glomerulosclerosis

    Am J Cardiol

    (1972)
  • S.W. Zarich et al.

    Diabetic cardiomyopathy

    Am Heart J

    (1989)
  • E.J. Benjamin et al.

    Independent risk factors for atrial fibrillation in a population-based cohort

    JAMA

    (1994)
  • B.M. Psaty et al.

    Incidence of and risk factors for atrial fibrillation in older adults

    Circulation

    (1997)
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    This study was supported by grants from the St. Luke's Life Science Institute, Tokyo, Japan.

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