Stroke, thromboembolism and bleeding in patients with atrial fibrillation according to the EHRA valvular heart disease classification

Aims: We compared thromboembolic (TE) and bleeding risks in patients with atrial fibrillation (AF) according to the new 'Evaluated Heartvalves, Rheumatic or Artificial' (EHRA) valve classification. Methods: Patients were divided into 3 categories: (i) EHRA type 1 corresponds to the previous 'valvular' AF patients, with either rheumatic mitral valve stenosis or mechanical prosthetic heart valves; (ii) EHRA type 2 includes AF patients with other valvular heart disease (VHD) and valve bioprosthesis or repair; and (iii) 'non-VHD controls' i.e. all AF patients with neither VHD nor post-surgical valve disease. Results: Among 8962 AF patients seen between 2000 and 2010, 357 (4%) were EHRA type 1, 1754 (20%) were EHRA type 2 and 6851 (76%) non-VHD controls. EHRA type 2 patients were older and had a higher CHA(2)DS(2)-VASc and HAS-BLED scores than either type 1 and non-VHD patients. After a mean follow-up of 1264 +/- 1160 days, the occurrence of TE events was higher in EHRA type 2 than non-VHD patients (HR (95% CI): 1.30 1.09-1.54), p = 0.003; also, p = 0.31 for type 1 vs 2, p = 0.68 for type 1 vs non-VHD controls). The rate of major BARC bleeding events for AF patients was higher in either EHRA type 1 (HR (95% CI): 3.16(2.11-4.72), p < 0.0001) or type 2 (HR (95% CI): 2.19(1.69-2.84), p < 0.0001) compared to non-VHD controls. Conclusion: The EHRA valve classification of AF patients with VHD appears useful in categorizing these patients, in terms of TE and bleeding risks. This classification can be used in clinical practice for appropriate choices of oral anticoagulation therapy and follow-up. (c) 2018 Elsevier B.V. All rights reserved.