Skip to main content
SpringerLink
Log in

H2ARDD score as a feasible predictor of heart failure events in patients with atrial fibrillation: a validation study

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

It was reported that the H2ARDD score (organic heart diseases = 2 points, anemia = 1 point, renal dysfunction = 1 point, diabetes = 1 point, and diuretic use = 1point; range 0 to 6 points) may help identify patients with AF at high risk for HF events. However, this score has not been externally validated. The objective of this study was to evaluate the usefulness of H2ARDD score in predicting HF events in patients with AF. We used a prospective database of patients with AF, and Cox-proportional hazards models were used to assess the risk of HF events. The outcome of interest was defined as HF events including new-onset HF and death from HF. Of 562 AF patients, 518 (mean 69.7 ± 9.7 years-old, 64.9% men) met study criteria, and 84 (16.2%) developed HF events during a mean follow–up of 54 ± 42 months. In multivariable analyses, H2ARDD score was shown as a significant predictor for HF events [hazard ratio (HR): 1.56, 95% confidence interval (CI): 1.36–1.79], independent of age (per 10 years, HR: 1.35, 95% CI: 1.03–1.78). In the Kaplan–Meier analyses stratified by H2ARDD score categories (0–2, 3–4, 5–6), the patients with higher H2ARDD scores had significantly worse HF event-free survival (log-rank P < 0.0001). The area under the ROC curve was 0.71 (95% CI: 0.65–0.77, P < 0.0001). The sensitivity and specificity at a cut-off score of ≥ 3 were 60% and 71%, respectively. In conclusion, the H2ARDD score may be feasible for HF risk stratification in patients with AF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The original data presented in this study are included in the article, further inquiries can be directed to the corresponding author.

References

  1. Taniguchi N, Miyasaka Y, Suwa Y, Harada S, Nakai E, Shiojima I (2020) Heart failure in atrial fibrillation - an update on clinical and echocardiographic implications. Circ J 84:1212–1217

    Article  PubMed  Google Scholar 

  2. Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, Gillum RF, Kim YH, McAnulty JH Jr, Zheng ZJ, Forouzanfar MH, Naghavi M, Mensah GA, Ezzati M, Murray CJ (2014) Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 129:837–847

    Article  PubMed  Google Scholar 

  3. Piccini JP, Hammill BG, Sinner MF, Hernandez AF, Walkey AJ, Benjamin EJ, Curtis LH, Heckbert SR (2014) Clinical course of atrial fibrillation in older adults: the importance of cardiovascular events beyond stroke. Eur Heart J 35:250–256

    Article  PubMed  Google Scholar 

  4. Bassand JP, Accetta G, Camm AJ, Cools F, Fitzmaurice DA, Fox KA, Goldhaber SZ, Goto S, Haas S, Hacke W, Kayani G, Mantovani LG, Misselwitz F, Ten Cate H, Turpie AG, Verheugt FW, Kakkar AK (2016) Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF. Eur Heart J 37:2882–2889

    Article  PubMed  PubMed Central  Google Scholar 

  5. Vermond RA, Geelhoed B, Verweij N, Tieleman RG, Van der Harst P, Hillege HL, Van Gilst WH, Van Gelder IC, Rienstra M (2015) Incidence of atrial fibrillation and relationship with cardiovascular events, heart failure, and mortality: a community-based study from the Netherlands. J Am Coll Cardiol 66:1000–1007

    Article  PubMed  Google Scholar 

  6. Pandey A, Kim S, Moore C, Thomas L, Gersh B, Allen LA, Kowey PR, Mahaffey KW, Hylek E, Peterson ED, Piccini JP, Fonarow GC (2017) Predictors and prognostic implications of incident heart failure in patients with prevalent atrial fibrillation. JACC Heart Fail 5:44–52

    Article  PubMed  Google Scholar 

  7. Santhanakrishnan R, Wang N, Larson MG, Magnani JW, McManus DD, Lubitz SA, Ellinor PT, Cheng S, Vasan RS, Lee DS, Wang TJ, Levy D, Benjamin EJ, Ho JE (2016) Atrial fibrillation begets heart failure and vice versa: temporal associations and differences in preserved versus reduced ejection fraction. Circulation 133:484–492

    Article  PubMed  PubMed Central  Google Scholar 

  8. Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna W, Seward JB, Iwasaka T, Tsang TS (2006) Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: a community-based study over two decades. Eur Heart J 27:936–941

    Article  PubMed  Google Scholar 

  9. Gomez-Outes A, Lagunar-Ruiz J, Terleira-Fernandez AI, Calvo-Rojas G, Suarez-Gea ML, Vargas-Castrillon E (2016) Causes of death in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol 68:2508–2521

    Article  PubMed  Google Scholar 

  10. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ (2001) Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285:2864–2870

    Article  CAS  PubMed  Google Scholar 

  11. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL (2021) 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 42:373–498

    Article  PubMed  Google Scholar 

  12. Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Seward JB, Bailey KR, Iwasaka T, Tsang TS (2005) Time trends of ischemic stroke incidence and mortality in patients diagnosed with first atrial fibrillation in 1980 to 2000: report of a community-based study. Stroke 36:2362–2366

    Article  PubMed  Google Scholar 

  13. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 137:263–272

    Article  PubMed  Google Scholar 

  14. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW (2019) 2019 aha/ACC/HRS FOCUSED UPDATE OF the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 74:104–132

    Article  PubMed  Google Scholar 

  15. McManus DD, Rienstra M, Benjamin EJ (2012) An update on the prognosis of patients with atrial fibrillation. Circulation 126:e143-146

    Article  PubMed  PubMed Central  Google Scholar 

  16. Chamberlain AM, Gersh BJ, Alonso A, Chen LY, Berardi C, Manemann SM, Killian JM, Weston SA, Roger VL (2015) Decade-long trends in atrial fibrillation incidence and survival: a community study. Am J Med 128:260–267

    Article  PubMed  Google Scholar 

  17. Miyasaka Y, Barnes ME, Bailey KR, Cha SS, Gersh BJ, Seward JB, Tsang TS (2007) Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study. J Am Coll Cardiol 49:986–992

    Article  PubMed  Google Scholar 

  18. Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, Ikonomidis JS, Khavjou O, Konstam MA, Maddox TM, Nichol G, Pham M, Pina IL, Trogdon JG (2013) Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail 6:606–619

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Suzuki S, Sagara K, Otsuka T, Matsuno S, Funada R, Uejima T, Oikawa Y, Yajima J, Koike A, Nagashima K, Kirigaya H, Sawada H, Aizawa T, Yamashita T (2012) A new scoring system for evaluating the risk of heart failure events in Japanese patients with atrial fibrillation. Am J Cardiol 110:678–682

    Article  PubMed  Google Scholar 

  20. McKee PA, Castelli WP, McNamara PM, Kannel WB (1971) The natural history of congestive heart failure: the Framingham study. N Engl J Med 285:1441–1446

    Article  CAS  PubMed  Google Scholar 

  21. Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, Seward JB, Tsang TS (2006) Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation 114:119–125

    Article  PubMed  Google Scholar 

  22. Ukita K, Egami Y, Nakamura H, Matsuhiro Y, Yasumoto K, Tsuda M, Okamoto N, Tanaka A, Matsunaga-Lee Y, Yano M, Shutta R, Sakata Y, Nishino M, Tanouchi J (2021) Predictors of improvement of left ventricular systolic function after catheter ablation of persistent atrial fibrillation in patients with heart failure with reduced ejection fraction. Heart Vessels 36(8):1212–1218

    Article  PubMed  Google Scholar 

  23. Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, Merkely B, Pokushalov E, Sanders P, Proff J, Schunkert H, Christ H, Vogt J, Bansch D (2018) Catheter ablation for atrial fibrillation with heart failure. N Engl J Med 378:417–427

    Article  PubMed  Google Scholar 

  24. Esato M, An Y, Ogawa H, Wada H, Hasegawa K, Tsuji H, Abe M, Akao M (2021) Major adverse cardiovascular events and mortality after catheter ablation in Japanese patients with atrial fibrillation: the Fushimi AF Registry. Heart Vessels 36:1219–1227

    Article  PubMed  Google Scholar 

  25. Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, Böhm M, Brunner-La Rocca HP, Choi DJ, Chopra V, Chuquiure-Valenzuela E, Giannetti N, Gomez-Mesa JE, Janssens S, Januzzi JL, Gonzalez-Juanatey JR, Merkely B, Nicholls SJ, Perrone SV, Piña IL, Ponikowski P, Senni M, Sim D, Spinar J, Squire I, Taddei S, Tsutsui H, Verma S, Vinereanu D, Zhang J, Carson P, Lam CSP, Marx N, Zeller C, Sattar N, Jamal W, Schnaidt S, Schnee JM, Brueckmann M, Pocock SJ, Zannad F, Packer M (2021) Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med 385:1451–1461

    Article  CAS  PubMed  Google Scholar 

  26. Packer M, Butler J, Zannad F, Filippatos G, Ferreira JP, Pocock SJ, Carson P, Anand I, Doehner W, Haass M, Komajda M, Miller A, Pehrson S, Teerlink JR, Schnaidt S, Zeller C, Schnee JM, Anker SD (2021) Effect of empagliflozin on worsening heart failure events in patients with heart failure and preserved ejection fraction: EMPEROR-preserved trial. Circulation 144:1284–1294

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was supported by a Grant-in-Aid for Scientific Research © (Grant number 26461096) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (Tokyo, Japan).

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine II, Kansai Medical University, 2-5-1, Shin-Machi, Hirakata, Osaka, 573-1010, Japan

    Naoki Taniguchi, Yoko Miyasaka, Yoshinobu Suwa, Shoko Harada, Eri Nakai & Ichiro Shiojima

Authors
  1. Naoki Taniguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoko Miyasaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshinobu Suwa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shoko Harada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eri Nakai
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ichiro Shiojima
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: Yoko Miyasaka, Naoki Taniguchi; Acquisition of data: Naoki Taniguchi, Yoshinobu Suwa; Analysis and interpretation of data: Naoki Taniguchi, Yoko Miyasaka; Drafting of the manuscript: Naoki Taniguchi, Yoko Miyasaka, Ichiro Shiojima; Critical revision of the manuscript for important intellectual content: Yoko Miyasaka, Naoki Taniguchi, Yoshinobu Suwa, Shoko Harada, Eri Nakai, Ichiro Shiojima; Obtained funding: Yoko Miyasaka.

Corresponding author

Correspondence to Yoko Miyasaka.

Ethics declarations

Conflict of interest

All authors declare no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taniguchi, N., Miyasaka, Y., Suwa, Y. et al. H2ARDD score as a feasible predictor of heart failure events in patients with atrial fibrillation: a validation study. Heart Vessels 38, 1035–1041 (2023). https://doi.org/10.1007/s00380-023-02252-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-023-02252-x

Keywords

Search

Navigation