ADA Score for Predicting Cardiovascular Events in Atrial Fibrillation

Author(s): Pasquale Pignatelli, Emanuele Valeriani, Daniele Pastori, Simona Bartimoccia, Cristina Nocella, Vittoria Cammisotto, Valentina Castellani, Raffaele Parisella, Irene Di Meo, Roberto Carnevale, Giuseppe Paolisso, Arianna Pannunzio, Danilo Menichelli, Maria R Rizzo, Francesco Violi

Objective: To investigate the ADA score for major adverse cardiovascular events (MACE) prediction in patients with atrial fibrillation (AF) on anticoagulation.

Patients and Methods: This is a prospective cohort study including patients with AF receiving anticoagulant therapy from 2013 to 2023 if they consented to participate in the study. Principal endpoint was MACE occurrence – including non-fatal acute myocardial infarction, nonfatal acute ischemic stroke, non-fatal acute peripheral artery event, and cardiovascular death – during 1-year follow-up. Patients were divided into low (ADA score <49), and high risk (ADA score ≥ 49).

Results: Twenty-one out of 1000 patients (2.1%) experienced a MACE. Patients with MACE were older, more frequently affected by coronary artery disease, had lower albumin, higher D-dimer, and higher ADA score values compared to patients without MACE. High-risk patients had more often arterial hypertension, heart failure, and a history of stroke. Patients at higher risk had a significantly greater risk of MACE compared to lowrisk patients (risk ratio, 3.39; 95% confidence interval, 1.23-9.32). The c-statistic of ADA score was 0.67 (95% confidence intervals, 0.54 to 0.77) with a sensitivity of 86% (95% confidence intervals, 43% to 99%), and a specificity of 50% (95% confidence intervals, 46% to 94%).

Conclusions: The ADA score has a good performance for MACE prediction in patients with AF. A more aggressive management of cardiovascular risk factors and comorbidities should be warranted for at-risk patients as identified by ADA score ≥ 49.