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

ORBIT-AF Patients & Investigators

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)152-157
Number of pages6
JournalInternational Journal of Cardiology
Volume274
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Keywords

  • Atrial fibrillation
  • Renal function
  • Risk prediction
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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