Dataset Information

Mortality Prediction of the CHA₂DS₂-VASc Score, the HAS-BLED Score, and Their Combination in Anticoagulated Patients with Atrial Fibrillation.

ABSTRACT:

Background and objectives

Atrial fibrillation (AF) is associated with increased mortality, predictors of which are poorly characterized. We investigated the predictive power of the commonly used CHA₂DS₂-VASc score (congestive heart failure, hypertension, age ? 75 years [doubled], diabetes, stroke/transient ischemic attack/thromboembolism [doubled], vascular disease [prior myocardial infarction, peripheral artery disease, or aortic plaque], age 65-75 years, sex category [female]), the HAS-BLED score (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio [INR], elderly [age ? 65 years], drugs/alcohol concomitantly), and their combination for mortality in AF patients.

Methods

The PREvention oF thromboembolic events-European Registry in Atrial Fibrillation (PREFER in AF) was a prospective registry including AF patients across seven European countries. We used logistic regression to analyze the relationship between the CHA₂DS₂-VASc and HAS-BLED scores and outcomes, including mortality, at one year. We evaluated the performance of logistic regression models by discrimination measures (C-index and DeLong test) and calibration measures (Hosmer and Lemeshow goodness-of-fit and integrated discrimination improvement (IDI), with bootstrap techniques for internal validation.

Results

In 5209 AF patients with complete information on both scores, average one-year mortality was 3.1%. We found strong gradients between stroke/systemic embolic events (SSE), major bleeding and-specifically-mortality for both CHA₂DS₂-VASc and HAS-BLED scores, with a similar C-statistic for event prediction. The predictive power of the models with both scores combined, removing overlapping components, was significantly enhanced (p < 0.01) compared to models including either CHA₂DS₂-VASc or HAS-BLED alone: for mortality, C-statistic: 0.740, compared to 0.707 for CHA₂DS₂-VASc or 0.646 for HAS-BLED alone. IDI analyses supported the significant improvement for the combined score model compared to separate score models for all outcomes.

Conclusions

Both the CHA₂DS₂-VASc and the HAS-BLED scores predict mortality similarly in patients with AF, and a combination of their components increases prediction significantly. Such combination may be useful for investigational and-possibly-also clinical purposes.

SUBMITTER: Morrone D

PROVIDER: S-EPMC7764787 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Mortality Prediction of the CHA<sub>2</sub>DS<sub>2</sub>-VASc Score, the HAS-BLED Score, and Their Combination in Anticoagulated Patients with Atrial Fibrillation.

Morrone Doralisa D Kroep Sonja S Ricci Fabrizio F Renda Giulia G Patti Giuseppe G Kirchhof Paulus P Chuang Ling-Hsiang LH van Hout Ben B De Caterina Raffaele R

Journal of clinical medicine 20201209 12

<h4>Background and objectives</h4>Atrial fibrillation (AF) is associated with increased mortality, predictors of which are poorly characterized. We investigated the predictive power of the commonly used CHA<sub>2</sub>DS<sub>2</sub>-VASc score (congestive heart failure, hypertension, age ≥ 75 years [doubled], diabetes, stroke/transient ischemic attack/thromboembolism [doubled], vascular disease [prior myocardial infarction, peripheral artery disease, or aortic plaque], age 65-75 years, sex categ ...[more]

PMID: 33317069

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Project description:ImportanceCurrent guidelines support treating atrial fibrillation (AF) and atrial flutter (AFL) as equivalent risk factors for ischemic stroke stratified by CHA2DS2-VASc scores, recommending anticoagulation therapy for patients with a CHA2DS2-VASc score of 2 or higher, but some studies found differences in clinical outcomes.ObjectiveTo investigate differences in clinical outcomes among AF, AFL, and matched control cohorts.Design, setting, and participantsThis nationwide cohort study analyzed data from the Taiwan National Health Insurance Research Database from January 1, 2001, through December 31, 2012. Follow-up and data analysis ended December 31, 2012. A total of 219 416 age- and sex-matched individuals participated in the study. Clinical outcomes were compared after stratification by CHA2DS2-VASc score (possible score range, 0-9; higher scores indicate greater risk of ischemic stroke).Main outcomes and measuresIschemic stroke, heart failure hospitalization, and all-cause mortality among the AF, AFL, and matched control cohorts were analyzed using Cox proportional hazards regression.ResultsThis study comprised 188?811 patients in the AF cohort (mean [SD] age, 73.8 [13.4] years; 104 703 [55.5%] male), 6121 patients in the AFL cohort (mean [SD] age, 67.7 [15.8] years; 3735 [61.0%] male), and 24?484 patients in the matched control cohort (mean [SD] age, 67.3 [15.6] years; 14 940 [61.0%] male). The patients with AF were older, were more predominantly female, and had higher CHA2DS2-VASc scores than the patients with AFL and the control participants. After stratification by CHA2DS2-VASc score, the incidence densities (IDs; events per 100 person-years) of ischemic stroke (AF cohort: ID, 3.08; 95% CI, 3.03-3.13; AFL cohort: ID, 1.45; 95% CI, 1.28-1.62; controls: ID, 0.97; 95% CI, 0.92-1.03), heart failure hospitalization (AF cohort: ID, 3.39; 95% CI, 3.34-3.44; AFL cohort: ID, 1.57; 95% CI, 1.39-1.74; controls: ID, 0.32; 95% CI, 0.29-0.35), and all-cause mortality (AF cohort: ID, 17.8; 95% CI, 17.7-17.9; AFL cohort: ID, 13.9; 95% CI, 13.4-14.4; controls: ID, 4.2; 95% CI, 4.1-4.4) were significantly higher in the AF cohort than in the matched control cohort. For the AFL cohort vs the matched control cohort, the incidences of heart failure hospitalization and all-cause mortality were significantly higher across all levels, but the incidence of ischemic stroke was only significantly higher at CHA2DS2-VASc scores of 5 to 9. For the AF cohort vs the AFL cohort, the incidences of ischemic stroke and heart failure hospitalization were significantly higher at a CHA2DS2-VASc score of 1 or higher, but the incidence of all-cause mortality was significantly higher only at CHA2DS2-VASc scores of 1 to 3.Conclusions and relevanceThis study found different clinical outcomes between patients with AFL and AF and those without AF and AFL. The current recommended level of the CHA2DS2-VASc score in preventing ischemic stroke in patients with AFL should be reevaluated.

Project description:AimsThe GRACE and CHA2DS2-VASc risk score are developed for risk stratification in patients with acute coronary syndrome and AF, respectively. We aimed to assess the predictive performance of the GRACE score and CHA2DS2-VASc score among patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI).MethodsConsecutive patients with a diagnosis of AF admitted to our hospital for PCI between January 2016 and December 2018 were included and followed up for at least 1 year. The primary endpoint was a composite of major adverse cardiac events (MACEs) including all-cause mortality, repeat revascularization, myocardial infarction, or ischaemic stroke.ResultsA total of 1452 patients were identified. Cox regression demonstrated that the GRACE (HR 1.014, 95% CI 1.008-1.020, p < 0.001) but not the CHA2DS2-VASc score was associated with the risk of MACEs. Both GRACE and CHA2DS2-VASc scores were predictive of all-cause mortality with HR of 1.028 (95% CI 1.020-1.037, p < 0.001) and 1.334 (95% CI 1.107-1.632, p = 0.003). Receiver operating characteristic analyses showed both scores had similar discrimination capacity for all-cause mortality (C-statistic: 0.708 for GRACE vs. 0.661 for CHA2DS2-VASc, p = 0.299). High GRACE score was also significantly associated with increased risk of ischaemic stroke (HR 1.018, 95% CI 1.005-1.031, p = 0.006) and major bleeding (HR 1.012, 95% CI 1.001-1.024, p = 0.039), whereas high CHA2DS2-VASc score was not.ConclusionsHigh GRACE score but not CHA2DS2-VASc score were both associated with an increased risk of MACEs after PCI in patients with AF. The GRACE and CHA2DS2-VASc scores have similar predictive performance for predicting all-cause mortality.Key messages:In patients with AF undergoing PCI, increasing GRACE but not CHA2DS2-VASc scores was independently associated high risk of MACEs.The GRACE score could also help identify patients at higher risk of stroke and major bleeding.Both GRACE and CHA2DS2-VASc scores showed good ability in the prediction of all-cause mortality.

Project description:BackgroundNew-onset atrial fibrillation (NOAF) is a common cardiac arrhythmia observed in patients with acute myocardial infarction (AMI) and is associated with worse outcomes. While uric acid has been proposed as a potential biomarker for predicting atrial fibrillation, its association with NOAF in patients with AMI and its incremental discriminative ability when added to the CHA2DS2-VASc score are not well established.MethodsWe conducted a retrospective analysis of 1000 consecutive patients with AMI without a history of atrial fibrillation between January 2018 and December 2020. Continuous electrocardiographic monitoring was performed during the patients' hospital stay to detect NOAF. We assessed the predictive ability of the different scoring models using receiver operating characteristic (ROC) curves. In addition, we employed the area under the curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) analyses to assess the incremental discriminative ability of uric acid when added to the CHA2DS2-VASc score.ResultsNinety-three patients (9.3%) developed NOAF during hospitalisation. In multivariate regression analyses, the adjusted odds ratio (OR) for NOAF was 1.439 per one standard deviation increase in uric acid level (95% confidence intervals (CI):1.182-1.753, p < 0.001). The ROC curve analysis revealed that the AUC for uric acid was 0.667 (95% CI:0.601-0.719), while the AUC for the CHA2DS2-VASc score was 0.678 (95% CI:0.623-0.734). After integrating the uric acid variable into the CHA2DS2-VASc score, the combined score yielded an improved AUC of 0.737 (95% CI:0.709-0.764, p = 0.009). Furthermore, there was a significant improvement in both IDI and NRI, indicating an incremental improvement in discriminative ability (IDI = 0.041, p < 0.001; NRI = 0.627, p < 0.001).ConclusionOur study suggests that uric acid level is an independent risk factor for the development of NOAF after AMI. Furthermore, the incorporation of uric acid into the CHA2DS2-VASc score significantly improves the discriminative ability of the score in identifying patients at high risk for NOAF.

Dataset Information

Mortality Prediction of the CHA₂DS₂-VASc Score, the HAS-BLED Score, and Their Combination in Anticoagulated Patients with Atrial Fibrillation.

Background and objectives

Methods

Results

Conclusions

Publications

Mortality Prediction of the CHA<sub>2</sub>DS<sub>2</sub>-VASc Score, the HAS-BLED Score, and Their Combination in Anticoagulated Patients with Atrial Fibrillation.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

Mortality Prediction of the CHA2DS2-VASc Score, the HAS-BLED Score, and Their Combination in Anticoagulated Patients with Atrial Fibrillation.

Background and objectives

Methods

Results

Conclusions

Publications

Mortality Prediction of the CHA<sub>2</sub>DS<sub>2</sub>-VASc Score, the HAS-BLED Score, and Their Combination in Anticoagulated Patients with Atrial Fibrillation.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Mortality Prediction of the CHA₂DS₂-VASc Score, the HAS-BLED Score, and Their Combination in Anticoagulated Patients with Atrial Fibrillation.