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

Journal of Clinical Medicine

Giuseppe Patti¹  Doralisa Morrone²  Raffaele De Caterina²  Fabrizio Ricci³  Giulia Renda³  Ben van Hout⁴  Ling-Hsiang Chuang⁴  Sonja Kroep⁴  Paulus Kirchhof⁵ 

[1] Department of Thoracic and Cardiovascular Diseases, University of Eastern Piedmont, 28100 Novara, Italy;Division of Cardiology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 50124 Pisa, Italy;Institute of Cardiology and Center of Excellence on Aging, G. d’Annunzio University, 66100 Chieti-Pescara, Italy;Pharmerit—an OPEN Health Company, 3068 AV Rotterdam, The Netherlands;University of Birmingham Institute of Cardiovascular Sciences, University of Birmingham, UHB and SWBH NHS Trusts, Birmingham B15 2TT, UK;

关键词: atrial fibrillation;    morbidity;    mortality;    risk scores;    CHA₂DS₂-VASc score;    HAS-BLED score;   

DOI  :  10.3390/jcm9123987

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown