Abstract 15038: Predicting the Risk of Failure and Recurrence After Electrical Cardioversion for Acute Atrial Fibrillation: Derivation and Validation of the AF-CVS Score
Objective: To derive and validate a clinical risk stratification tool for identifying patients at high risk for unsuccessful outcome following electrical cardioversion (ECV) for acute atrial fibrillation (AF).
Background: ECV is the standard treatment for acute AF, but identification of patients with increased risk of ECV failure or AF recurrence is of importance for easy clinical decision making.
Methods: Data on 2,868 patients undergoing 5,713 cardioversions of acute AF in three Finnish hospitals was included in the analysis. The composite of cardioversion failure and recurrence of AF within 30 days after ECV was recorded. Patients from western (n=3716 cardioversions) and eastern (n=1997 cardioversions) hospital regions were used as derivation and validation datasets, respectively. A clinical scoring system (AF-CVS, see Figure footnote) was created using logistic regression analyses with a repeated measures model in the derivation dataset.
Results: A multivariable analysis for prediction of the composite end-point resulted in identification of five clinical variables for increased risk: Age (OR 1.31, 1.13-1.52); First-time AF or not (previous AF episode, OR 1.55, 1.19-2.02): Cardiac failure (OR 1.52, 1.08-2.13): Vascular disease (OR 1.38, 1.11-1.71); Short interval from previous AF episode (within one month before ECV, OR 2.31, 1.83-2.91). C-index for this score was 0.67 (95% CI, 0.65-0.69) with Hosmer-Lemeshow p-value 0.84. With high (>5) scores (i.e. 12-16% of the patients), the rate of composite end point was ~40% in both cohorts and amongst low risk patients (score <3), the composite end point rate was ~10% (Figure).
Conclusions: The risk of failure of ECV and early recurrence of AF can be predicted with simple clinical characteristics. The AF-CVS score is a simple clinical score to aid decision making in predicting an unsuccessful ECV result.
Author Disclosures: S. Jaakkola: None. G.Y. Lip: Speakers Bureau; Modest; Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche and Daiichi-Sankyo. Consultant/Advisory Board; Modest; Bayer/Jensen J&J, Astellas, Merck, Sanofi, BMS/Pfizer, Biotronik, Medtronic, Portola, Boehringer Ingelheim, Microlife and Daiichi-Sankyo. I. Nuotio: None. F. Biancari: None. J.E. Hartikainen: Speakers Bureau; Modest; Cardiome, St Jude Medical and Biotronic. Consultant/Advisory Board; Modest; Astra Zeneca, Amgen and Bayer. J.K. Airaksinen: Research Grant; Modest; Grants from the Finnish Foundation for Cardiovascular Research. Other; Modest; Lecture fees from Astra Zeneca, Boehringer Ingelheim, Cardiome, MSD, Novartis and Pfizer.
- © 2016 by American Heart Association, Inc.