Abstract 15298: A New Scoring System for the Prediction of Paroxysmal Atrial Fibrillation Progression and Relationship with Clinical Outcomes

Abstract

Background: The progression of paroxysmal atrial fibrillation (AF) to persistent, long lasting persistent AF is often associated with poor clinical outcomes. Although some factors were known to be useful, their accuracy and clinical relationship are not good enough to predict the progression. Hypothesis: We aimed to construct a new predictive scoring system for the progression of paroxysmal AF. Also, we aimed to evaluate the relationship of a new predicting system with clinical outcomes. Methods: We analyzed 2,047 patients (61.2±13.2 years old, 1158 males) who were newly diagnosed as AF from January 2006 to January 2013. Progression of AF and clinical outcomes were analyzed after at least one-year follow-up. Clinical outcomes were defined as the composite of death, hospitalization due to heart failure, and new onset stroke. Independent predictors of AF progression were analyzed and incorporated into a new predictive scoring system. Its predictive accuracy was compared with CHADS 2 , CHA 2 DS 2 -VASc, and HATCH scoring system. Results: Paroxysmal AF was diagnosed in 449 (21.6%) patients. Among them, 78 (17.4%) patients progressed to persistent AF. Multivariate analysis showed congestive heart failure (LVEF <45%), hypertension, older age (≥65 years old), chronic renal disease, previous history of stroke, COPD, left atrial enlargement (≥43mm), high NT-pro BNP serum levels (≥1,000 pg/mL) were independently associated with the progression. A new scoring system was calculated with the sum of 1 point at each independent risk factor. It showed better predictive accuracy for AF progression (area under curve (AUC): 0.754, 95% confidence interval [CI] 0.69-0.83, p<0.001) than CHADS 2 (AUC 0.643; 95% CI 0.58-0.71), CHA 2 DS 2 -VASc (AUC 0.647; 95% CI 0.58-0.71), and HATCH score (AUC 0.675; 95% CI 0.61-0.74). Also, it showed better predictive accuracy for the composite of clinical outcomes (AUC 0.764, 95% CI 0.68-0.83, p<0.001) with linear correlation (linear p<0.001) than the other scoring systems. More than 60% of patients with paroxysmal AF progressed into sustained AF if the score by a new system was more than 3. Conclusions: A new scoring system may help to the prediction of AF progression and prognosis for clinical outcomes in patients with paroxysmal AF.