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Ding, Wern Yew; Proietti, Marco; Boriani, Giuseppe; Fauchier, Laurent; Blomström-Lundqvist, Carina; Marin, Francisco; Potpara, Tatjana S; Lip, Gregory Y H; Boriani, G; Lip, G Y H; Tavazzi, L; Maggioni, A P; Dan, G-A; Potpara, T; Nabauer, M; Marin, F; Kalarus, Z; Fauchier, L; Goda, A; Mairesse, G; Shalganov, T; Antoniades, L; Taborsky, M; Riahi, S; [...]

Clinical utility and prognostic implications of the novel 4S-AF scheme to characterize and evaluate patients with atrial fibrillation: a report from ESC-EHRA EORP-AF Long-Term General Registry

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  • Medientyp: E-Artikel
  • Titel: Clinical utility and prognostic implications of the novel 4S-AF scheme to characterize and evaluate patients with atrial fibrillation: a report from ESC-EHRA EORP-AF Long-Term General Registry
  • Beteiligte: Ding, Wern Yew; Proietti, Marco; Boriani, Giuseppe; Fauchier, Laurent; Blomström-Lundqvist, Carina; Marin, Francisco; Potpara, Tatjana S; Lip, Gregory Y H; Boriani, G; Lip, G Y H; Tavazzi, L; Maggioni, A P; Dan, G-A; Potpara, T; Nabauer, M; Marin, F; Kalarus, Z; Fauchier, L; Goda, A; Mairesse, G; Shalganov, T; Antoniades, L; Taborsky, M; Riahi, S; [...]
  • Erschienen: Oxford University Press (OUP), 2022
  • Erschienen in: EP Europace
  • Sprache: Englisch
  • DOI: 10.1093/europace/euab280
  • ISSN: 1099-5129; 1532-2092
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aims</jats:title> <jats:p>The 4S-AF classification scheme comprises of four domains: stroke risk (St), symptoms (Sy), severity of atrial fibrillation (AF) burden (Sb), and substrate (Su). We sought to examine the implementation of the 4S-AF scheme in the EORP-AF General Long-Term Registry and compare outcomes in AF patients according to the 4S-AF-led decision-making process.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and results </jats:title> <jats:p>Atrial fibrillation patients from 250 centres across 27 European countries were included. A 4S-AF score was calculated as the sum of each domain with a maximum score of 9. Of 6321 patients, 8.4% had low (St), 47.5% EHRA I (Sy), 40.5% newly diagnosed or paroxysmal AF (Sb), and 5.1% no cardiovascular risk factors or left atrial enlargement (Su). Median follow-up was 24 months. Using multivariable Cox regression analysis, independent predictors of all-cause mortality were (St) [adjusted hazard ratio (aHR) 8.21, 95% confidence interval (CI): 2.60–25.9], (Sb) (aHR 1.21, 95% CI: 1.08–1.35), and (Su) (aHR 1.27, 95% CI: 1.14–1.41). For CV mortality and any thromboembolic event, only (Su) (aHR 1.73, 95% CI: 1.45–2.06) and (Sy) (aHR 1.29, 95% CI: 1.00–1.66) were statistically significant, respectively. None of the domains were independently linked to ischaemic stroke or major bleeding. Higher 4S-AF score was related to a significant increase in all-cause mortality, CV mortality, any thromboembolic event, and ischaemic stroke but not major bleeding. Treatment of all 4S-AF domains was associated with an independent decrease in all-cause mortality (aHR 0.71, 95% CI: 0.55–0.92). For each 4S-AF domain left untreated, the risk of all-cause mortality increased substantially (aHR 1.35, 95% CI: 1.16–1.56).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion </jats:title> <jats:p>Implementation of the novel 4S-AF scheme is feasible, and treatment decisions based on this scheme improve mortality rates in AF.</jats:p> </jats:sec>
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