ROCKET-AF Heart Failure Subgroup Risk Index
- ROCKET-AF Heart Failure Subgroup Risk Index — explanation and context
This page presents an experimental composite index adapted to reflect the primary predictors and outcomes described in ROCKET-AF and its heart-failure subgroup analyses. The ROCKET-AF trial (rivaroxaban vs warfarin) enrolled a high-risk atrial fibrillation population and reported subgroup analyses examining outcomes among patients with heart failure, demonstrating that heart failure patients enrolled in ROCKET-AF had higher thromboembolic risk and different comorbidity profiles; renal dysfunction, prior stroke/TIA, and reduced left ventricular function were among factors associated with worse outcomes in subgroup reports. The index above assigns points to commonly reported adverse-outcome predictors (age ≥75, prior stroke/TIA, HF with reduced EF or advanced NYHA class, renal impairment, diabetes, hypertension, vascular disease, and persistent AF) to produce a simple summary score and illustrative risk bands. This composite is provided solely to mirror the kinds of risk drivers described in ROCKET-AF subgroup publications and to help clinicians/learners explore how multiple risk factors combine in HF patients with AF.
How to interpret this tool:
The numeric score is an experimental summary of established predictors; the associated "risk band" is an approximate mapping for educational demonstration and should not be used as a validated probability of stroke, bleeding, or death. For clinical decision-making about anticoagulation or advanced therapies, use validated tools (e.g., CHA2DS2-VASc for stroke risk, validated bleeding scores), guideline recommendations, and individual patient assessment.
References:
Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. N Engl J Med. 2011;365:981-992. (ROCKET-AF main trial).
van Diepen S, et al. Efficacy and safety of rivaroxaban in patients with heart failure and nonvalvular atrial fibrillation: insights from ROCKET-AF. Circ Heart Fail. 2013;6(4):... (ROCKET-AF HF subgroup analysis).
Singer DE, et al. Data From the ROCKET AF Clinical Trial: baseline characteristics and outcomes analyses. (ROCKET-AF dataset overview).
Breithardt G, et al. Clinical characteristics and outcomes with rivaroxaban vs warfarin in ROCKET-AF: subgroup insights. Eur Heart J. 2014.
Additional subgroup and outcomes analyses discussed in review and meta-analysis literature summarizing DOAC performance in HF subgroups.
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