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Incremental prognostic value of renal function for stroke prediction in atrial fibrillation.

Publication ,  Journal Article
O'Brien, EC; Holmes, DN; Thomas, L; Singer, DE; Fonarow, GC; Mahaffey, KW; Kowey, PR; Hylek, EM; Pokorney, SD; Ansell, JE; Pencina, MJ ...
Published in: Int J Cardiol
January 1, 2019

BACKGROUND: Renal function has been associated with an increased stroke risk in patients with atrial fibrillation (AF). However, whether renal function incrementally adds to risk prediction in both anticoagulated and non-anticoagulated patients with AF is unclear. METHODS: We used data from the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF)-a national, prospective, outpatient AF registry in patients aged >18 years (2010-2011). The association between baseline renal function and risk of stroke/systemic embolism (SSE) was evaluated in proportional hazards models adjusting for stroke risk score components. We compared discrimination of 2-year outcomes using C-indices and evaluated calibration by comparing event rates in ORBIT-AF to published rates from an external clinical trial population (ROCKET AF) and an observational cohort (ATRIA). RESULTS: Among 9743 patients included in the analysis, the median age was 75 years (interquartile range [IQR] 67-82), 89.5% were white, 43% were female, and 76% were taking oral anticoagulation (OAC). Over a median follow-up of 2.3 years, 214 SSE events occurred (1.00 per 100 patient-years). Continuous creatinine clearance (CrCl) was not associated with SSE risk after adjusting for other clinical factors (components of CHADS2 or CHA2DS2-VASc). Discrimination for predicting stroke (C-index; 95% CI) was similar for R2CHADS2 (0.65; 0.61-0.69), CHADS2 (0.65; 0.61-0.69), and CHA2DS2-VASc (0.66; 0.62-0.70). CONCLUSIONS AND RELEVANCE: In a community patient population with AF, renal dysfunction was not independently associated with embolic risk beyond other established risk factors in either OAC-treated or untreated patients. Additional study is needed to identify clinical factors that incrementally add to stroke risk prediction.

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Published In

Int J Cardiol

DOI

EISSN

1874-1754

Publication Date

January 1, 2019

Volume

274

Start / End Page

152 / 157

Location

Netherlands

Related Subject Headings

  • United States
  • Risk Factors
  • Risk Assessment
  • Registries
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Male
  • Kidney Function Tests
  • Kidney
 

Citation

APA
Chicago
ICMJE
MLA
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O’Brien, E. C., Holmes, D. N., Thomas, L., Singer, D. E., Fonarow, G. C., Mahaffey, K. W., … ORBIT-AF Patients & Investigators, . (2019). Incremental prognostic value of renal function for stroke prediction in atrial fibrillation. Int J Cardiol, 274, 152–157. https://doi.org/10.1016/j.ijcard.2018.07.113
O’Brien, Emily C., DaJuanicia N. Holmes, Laine Thomas, Daniel E. Singer, Gregg C. Fonarow, Kenneth W. Mahaffey, Peter R. Kowey, et al. “Incremental prognostic value of renal function for stroke prediction in atrial fibrillation.Int J Cardiol 274 (January 1, 2019): 152–57. https://doi.org/10.1016/j.ijcard.2018.07.113.
O’Brien EC, Holmes DN, Thomas L, Singer DE, Fonarow GC, Mahaffey KW, et al. Incremental prognostic value of renal function for stroke prediction in atrial fibrillation. Int J Cardiol. 2019 Jan 1;274:152–7.
O’Brien, Emily C., et al. “Incremental prognostic value of renal function for stroke prediction in atrial fibrillation.Int J Cardiol, vol. 274, Jan. 2019, pp. 152–57. Pubmed, doi:10.1016/j.ijcard.2018.07.113.
O’Brien EC, Holmes DN, Thomas L, Singer DE, Fonarow GC, Mahaffey KW, Kowey PR, Hylek EM, Pokorney SD, Ansell JE, Pencina MJ, Peterson ED, Piccini JP, ORBIT-AF Patients & Investigators. Incremental prognostic value of renal function for stroke prediction in atrial fibrillation. Int J Cardiol. 2019 Jan 1;274:152–157.
Journal cover image

Published In

Int J Cardiol

DOI

EISSN

1874-1754

Publication Date

January 1, 2019

Volume

274

Start / End Page

152 / 157

Location

Netherlands

Related Subject Headings

  • United States
  • Risk Factors
  • Risk Assessment
  • Registries
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Male
  • Kidney Function Tests
  • Kidney