title: Does von Willebrand factor improve the predictive ability of current risk stratification scores in patients with atrial fibrillation?
abstract: Von Willebrand factor (vWF) is a biomarker of endothelial dysfunction. We investigated its role on prognosis in anticoagulated atrial fibrillation (AF) patients and determined whether its addition to clinical risk stratification schemes improved event-risk prediction. Consecutive outpatients with non-valvular AF were recruited and rates of thrombotic/cardiovascular events, major bleeding and mortality were recorded. The effect of vWF on prognosis was calculated using a Cox regression model. Improvements in predictive accuracy over current scores were determined by calculating the integrated discrimination improvement (IDI), net reclassification improvement (NRI), comparison of receiver-operator characteristic (ROC) curves and Decision Curve Analysis (DCA). 1215 patients (49% males, age 76 (71-81) years) were included. Follow-up was almost 7 years. Significant associations were found between vWF and cardiovascular events, stroke, mortality and bleeding. Based on IDI and NRI, addition of vWF to CHA2DS2-VASc statistically improved its predictive value, but c-indexes were not significantly different. For major bleeding, the addition of vWF to HAS-BLED improved the c-index but not IDI or NRI. DCA showed minimal net benefit. vWF acts as a simple prognostic biomarker in AF and, whilst its addition to current scores statistically improves prediction for some endpoints, absolute changes and impact on clinical decision-making are marginal.
authors.affiliation: Cardiology Service, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL - FISABIO Foundation), Alicante, Spain.
authors.forename: Amaya
authors.initials: A
authors.lastname: García-Fernández
authors.affiliation: Department of Hematology and Clinical Oncology, Morales Meseguer University Hospital, University of Murcia, Biohealth Research Institute Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Roldán
authors.affiliation: Department of Cardiology, Virgen de la Arrixaca University Hospital, University of Murcia, Biohealth Research Institute Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Rivera-Caravaca
authors.affiliation: Department of Cardiology, Virgen de la Arrixaca University Hospital, University of Murcia, Biohealth Research Institute Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Hernández-Romero
authors.affiliation: Department of Cardiology, Virgen de la Arrixaca University Hospital, University of Murcia, Biohealth Research Institute Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
authors.affiliation: Department of Hematology and Clinical Oncology, Morales Meseguer University Hospital, University of Murcia, Biohealth Research Institute Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Vicente
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, City Hospital, University of Birmingham, Birmingham, United Kingdom.|Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: Department of Cardiology, Virgen de la Arrixaca University Hospital, University of Murcia, Biohealth Research Institute Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality; D000066491:Clinical Decision-Making; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D017382:Reactive Oxygen Species; D018570:Risk Assessment; D012307:Risk Factors; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D017382:Reactive Oxygen Species; D014841:von Willebrand Factor