GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: A Danish nationwide validation study

Frederik Dalgaard, Karen Pieper, Freek Verheugt, A. John Camm, Keith A. A. Fox, Ajay K. Kakkar, Jannik L. Pallisgaard, Peter V. Rasmussen, Henk Van Weert, Tommi Bo Lindhardt, Christian Torp-Pedersen, Gunnar H. Gislason, Martin H. Ruwald, Ralf E. Harskamp

Research output: Contribution to journalArticleAcademicpeer-review

22 Citations (Scopus)

Abstract

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 CHA 2 DS 2 VASc 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 CHA 2 DS 2 VASc 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 CHA 2 DS 2 VASc in predicting stroke/SE and comparable with HAS-BLED for predicting major bleeding.
Original languageEnglish
Article numbere033283
JournalBMJ Open
Volume9
Issue number11
DOIs
Publication statusPublished - 2019

Cite this