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Predictive value of bleeding risk scores in elderly patients with atrial fibrillation and oral anticoagulation

医学 心房颤动 内科学 统计的 临床终点 逻辑回归 试验预测值 心脏病学 回顾性队列研究 脑出血 随机对照试验 统计 数学 蛛网膜下腔出血
作者
P Dominguez Erquicia,Sergio Raposeiras‐Roubín,Emad Abu‐Assi,Andrea Lizancos-Castro,J A Parada Barcia,André González-García,Ana Ledo-Piñeiro,Vanesa A. Noriega-Caro,Carla Iglesias-Otero,Andrés Iñíguez
出处
期刊:Journal of Geriatric Cardiology [Science Press]
卷期号:20 (9): 684-692
标识
DOI:10.26599/1671-5411.2023.09.002
摘要

The predictive value of bleeding risk scores for atrial fibrillation in older patients is not as well known. The goal of this study was to evaluate the predictive value of HASBLED, ORBIT and ATRIA for major bleeding (MB) and intracranial hemorrhage (ICH) in patients ≥ 75 years with atrial fibrillation and oral anticoagulation (OAC).A retrospective unicenter study including patients ≥ 75 years with atrial fibrillation (AF) and OAC. A total of 7613 patients ≥ 75 years with AF and OAC included between 2014 and 2018 (registry: NCT04364516). We analyzed the discriminative value of HASBLED, ATRIA and ORBIT scores for bleeding endpoints (major bleeding as primary endpoint and intracerebral hemorrhage as secondary). Cox regression was used to predict major bleeding with each scale and also for searching other variables potentially predictor of major bleeding. Model discrimination was assessed using Harrell's C-statistic. Calibration was assessed with goodness-of-fit test proposed by Gronnesby and Borgan.During a mean follow up of 4.0 years (IQR: 2.4-5.7 years), 729 patients developed MB (2.61 per 100 patients/year) and 243 patients developed ICH (0.85 per 100 patients/year). Three scores showed a low discrimination for major bleeding, being ORBIT the best (HASBLED C statistic = 0.557; ATRIA C statistic = 0.568; ORBIT C statistic = 0.595) and also a low discrimination for ICH (HASBLED C statistic = 0.509; ATRIA C statistic = 0.522; ORBIT C statistic = 0.526). Among the variables that are part of the scores and other baseline characteristics, after multivariable adjustment only sex (male), dementia, prior admission for bleeding, anemia and liver disease were found as a predictors of MB.In older patients under oral anticoagulation with atrial fibrillation, the risk scores HASBLED, ATRIA and ORBIT showed a weak discrimination for major bleeding and intracranial hemorrhage. Therefore, other better alternatives should be evaluated for this purpose.
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