Usefulness of Red Cells Distribution Width to Predict Worse Outcomes in Patients With Atrial Fibrillation

https://doi.org/10.1016/j.amjcard.2019.08.008Get rights and content

Red cells distribution width (RDW) is a measure of red cell size variability, but little is known about the relation between RDW and outcomes in atrial fibrillation (AF).The aims of our study were to evaluate the association between RDW values, AF patients’ profile and outcomes. Consecutive patients with ECG-confirmed AF were divided in 3 groups according to tertiles of RDW values (≤13.5%, 13.6% to 14.6%, >14.6%).We enrolled 457 patients, 61.9% males, median (interquartile range) age 74 (66 to 80). Both CHA2DS2-VASc and HAS-BLED scores increased progressively according to RDW tertiles. During follow-up, there was an increased risk for all-cause death and the composite end point in the highest RDW tertile (p <0.001 for both outcomes). On multivariate Cox regression analysis, the highest RDW tertile was independently associated with all-cause death (hazard ratio [HR] 3.23, 95% confidence interval [CI] 1.04 to 10.00) and the composite end point (HR 2.04, 95% CI 1.12 to 3.70). RDW as a continuous variable was also independently associated with all cause death and the composite outcome (HR 1.16, 95% CI 1.02 to 1.31 and HR 1.16, 95% CI 1.05 to 1.27, respectively). In conclusion, in a real-life AF population, RDW is associated with clinical factors indicating a worse profile and is independently associated with increased risks of all-cause death and other clinical events.

Section snippets

Methods

From February 1st 2016 to August 31st 2017, we prospectively enrolled AF patients in 2 observational registries. The 2 registries, the first one promoted by the European Society of Cardiology (ESC)15 and the second being a spontaneous, nonfunded one, had similar design, being differentiated only by the time course, and were approved by the local ethics committee, and all the patients provided written informed consent. All patients were enrolled consecutively, with no overlap between the 2

Results

A total of 457 patients were enrolled with 176 (38.5%) being inpatients from the cardiology ward.

AF patients were categorized according to the RDW tertiles, as follows: (1) 171 (37.4%) in the lowest tertile; (2) 141 (30.9%) in the intermediate tertile; (3) 145 (31.7%) in the highest tertile. Clinical characteristics of patients according to RDW tertiles were reported in Table 1. Patients were progressively older in relation to increasing tertiles. No difference was found in terms of oral

Discussion

In this study, derived from a contemporary, real-world cohort of AF patients, we found that several clinical factors indicating a worse clinical profile are associated with higher RDW values. Second, a significant association between baseline RDW values and a worse profile in terms of CHA2DS2-VASc and HAS-BLED scores was found. Third, higher RDW values were associated with an increased rate of all-cause death and of the composite end point of clinically relevant events. In literature the

Disclosures

VLM reports small speaker's fee for Bayer, Boehringer, Daiichi Sankyo, Mylan; MP reports consulting activity for Boehringer Ingelheim; GYHL has served as consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo, and as speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo; GB has received small speaker's fee from Medtronic, Boston, Boehringer, and Bayer, outside of the submitted work. The other authors declare

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    Vincenzo Livio Malavasi, Marco Proietti, and Giuseppe Boriani take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

    All other authors contributed significantly to the paper with data collection and paper revision for important intellectual content. All authors read and approved the final version of the manuscript.

    Funding: No funding was received for this work.

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