The HAS-BLED score predicts long-term major bleeding and death in anticoagulated non-valvular atrial fibrillation patients undergoing electrical cardioversion

Amaya García-Fernández; Francisco Marín; Vanessa Roldán; Emilio Galcerá-Jornet; Juan Gabriel Martínez-Martínez; Mariano Valdés; Francisco Sogorb; Gregory Y H Lip

doi:10.1016/j.ijcard.2016.04.167

The HAS-BLED score predicts long-term major bleeding and death in anticoagulated non-valvular atrial fibrillation patients undergoing electrical cardioversion

Amaya García-Fernández, Francisco Marín, Vanessa Roldán, Emilio Galcerá-Jornet, Juan Gabriel Martínez-Martínez, Mariano Valdés, Francisco Sogorb, Gregory Y H Lip

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

5 Citationer (Scopus)

Abstract

BACKGROUND: Atrial fibrillation (AF) patients eligible for cardioversion tend to be younger and are at lower risk than 'general' AF clinic populations. We evaluated the incidence of major bleeding and death, as well as the predictive value of the HAS-BLED score in non-valvular AF patients who underwent electrical cardioversion (ECV).

METHODS: Consecutive non-valvular AF patients who underwent ECV were recruited. Major bleeding episodes and mortality were recorded. Factors associated with both endpoints and the predictive value of the HAS-BLED score were analysed.

RESULTS: 406 patients (281 males; age 66.9±10.9years) undergoing 571 ECV were included. After a follow-up of nearly 3years, 20 patients presented with major bleeding (1.9%/year;) and 26 patients died (2.4%/year). The HAS-BLED score predicted both major bleeding [c-statistics: 0.77; 95%CI: 0.71-0.83; p<0.001] and mortality [c-statistics: 0.83; 95%CI: 0.79-0.87; p<0.001]. Variables associated with bleeding were: renal impairment (HR: 4.35; 95%CI: 1.22-15.52; p=0.02), poor quality anticoagulation (HR: 3.21; 95%CI: 1.11-9.32; p=0.03), previous bleeding-predisposition (HR: 5.43; 95%CI: 1.76-16.75; p=0.003) and the HAS-BLED score (HR: 1.88; 95%CI: 1.34-2.64; p<0.001). Factors associated with mortality were: age (HR: 1.08; 95%CI: 1.03-1.14; p=0.004), poor quality anticoagulation (HR: 3.11; 95%CI: 1.15-8.36; p=0.02), previous bleeding-predisposition (HR: 5.90; 95%CI: 1.41-24.65; p=0.01), liver impairment (HR: 9.27; 95%CI:1.64-52.34; p=0.01), the CHA2DS2-VASc score (HR: 1.63; 95%CI: 1.18-2.26; p=0.003) and the HAS-BLED score (HR: 2.74; 95%CI: 1.86-4.04); p<0.001).

CONCLUSIONS: In AF patients undergoing ECV, major bleeding episodes and mortality were independently associated with poor quality anticoagulation control and previous bleeding-predisposition. The HAS-BLED score successfully predicted major bleeding and mortality.

Originalsprog	Engelsk
Tidsskrift	International Journal of Cardiology
Vol/bind	217
Sider (fra-til)	42-48
Antal sider	7
ISSN	0167-5273
DOI	https://doi.org/10.1016/j.ijcard.2016.04.167
Status	Udgivet - 3 maj 2016
Udgivet eksternt	Ja

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10.1016/j.ijcard.2016.04.167

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García-Fernández, A., Marín, F., Roldán, V., Galcerá-Jornet, E., Martínez-Martínez, J. G., Valdés, M., Sogorb, F., & Lip, G. Y. H. (2016). The HAS-BLED score predicts long-term major bleeding and death in anticoagulated non-valvular atrial fibrillation patients undergoing electrical cardioversion. International Journal of Cardiology, 217, 42-48. https://doi.org/10.1016/j.ijcard.2016.04.167

@article{2f23a1ace5644407b9d8eddbafa0dfca,

title = "The HAS-BLED score predicts long-term major bleeding and death in anticoagulated non-valvular atrial fibrillation patients undergoing electrical cardioversion",

abstract = "BACKGROUND: Atrial fibrillation (AF) patients eligible for cardioversion tend to be younger and are at lower risk than 'general' AF clinic populations. We evaluated the incidence of major bleeding and death, as well as the predictive value of the HAS-BLED score in non-valvular AF patients who underwent electrical cardioversion (ECV).METHODS: Consecutive non-valvular AF patients who underwent ECV were recruited. Major bleeding episodes and mortality were recorded. Factors associated with both endpoints and the predictive value of the HAS-BLED score were analysed.RESULTS: 406 patients (281 males; age 66.9±10.9years) undergoing 571 ECV were included. After a follow-up of nearly 3years, 20 patients presented with major bleeding (1.9%/year;) and 26 patients died (2.4%/year). The HAS-BLED score predicted both major bleeding [c-statistics: 0.77; 95%CI: 0.71-0.83; p<0.001] and mortality [c-statistics: 0.83; 95%CI: 0.79-0.87; p<0.001]. Variables associated with bleeding were: renal impairment (HR: 4.35; 95%CI: 1.22-15.52; p=0.02), poor quality anticoagulation (HR: 3.21; 95%CI: 1.11-9.32; p=0.03), previous bleeding-predisposition (HR: 5.43; 95%CI: 1.76-16.75; p=0.003) and the HAS-BLED score (HR: 1.88; 95%CI: 1.34-2.64; p<0.001). Factors associated with mortality were: age (HR: 1.08; 95%CI: 1.03-1.14; p=0.004), poor quality anticoagulation (HR: 3.11; 95%CI: 1.15-8.36; p=0.02), previous bleeding-predisposition (HR: 5.90; 95%CI: 1.41-24.65; p=0.01), liver impairment (HR: 9.27; 95%CI:1.64-52.34; p=0.01), the CHA2DS2-VASc score (HR: 1.63; 95%CI: 1.18-2.26; p=0.003) and the HAS-BLED score (HR: 2.74; 95%CI: 1.86-4.04); p<0.001).CONCLUSIONS: In AF patients undergoing ECV, major bleeding episodes and mortality were independently associated with poor quality anticoagulation control and previous bleeding-predisposition. The HAS-BLED score successfully predicted major bleeding and mortality.",

author = "Amaya Garc{\'i}a-Fern{\'a}ndez and Francisco Mar{\'i}n and Vanessa Rold{\'a}n and Emilio Galcer{\'a}-Jornet and Mart{\'i}nez-Mart{\'i}nez, {Juan Gabriel} and Mariano Vald{\'e}s and Francisco Sogorb and Lip, {Gregory Y H}",

note = "Copyright {\textcopyright} 2016. Published by Elsevier Ireland Ltd.",

year = "2016",

month = may,

day = "3",

doi = "10.1016/j.ijcard.2016.04.167",

language = "English",

volume = "217",

pages = "42--48",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier",

}

García-Fernández, A, Marín, F, Roldán, V, Galcerá-Jornet, E, Martínez-Martínez, JG, Valdés, M, Sogorb, F & Lip, GYH 2016, 'The HAS-BLED score predicts long-term major bleeding and death in anticoagulated non-valvular atrial fibrillation patients undergoing electrical cardioversion', International Journal of Cardiology, bind 217, s. 42-48. https://doi.org/10.1016/j.ijcard.2016.04.167

The HAS-BLED score predicts long-term major bleeding and death in anticoagulated non-valvular atrial fibrillation patients undergoing electrical cardioversion. / García-Fernández, Amaya; Marín, Francisco; Roldán, Vanessa et al.
I: International Journal of Cardiology, Bind 217, 03.05.2016, s. 42-48.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - The HAS-BLED score predicts long-term major bleeding and death in anticoagulated non-valvular atrial fibrillation patients undergoing electrical cardioversion

AU - García-Fernández, Amaya

AU - Marín, Francisco

AU - Roldán, Vanessa

AU - Galcerá-Jornet, Emilio

AU - Martínez-Martínez, Juan Gabriel

AU - Valdés, Mariano

AU - Sogorb, Francisco

AU - Lip, Gregory Y H

PY - 2016/5/3

Y1 - 2016/5/3

N2 - BACKGROUND: Atrial fibrillation (AF) patients eligible for cardioversion tend to be younger and are at lower risk than 'general' AF clinic populations. We evaluated the incidence of major bleeding and death, as well as the predictive value of the HAS-BLED score in non-valvular AF patients who underwent electrical cardioversion (ECV).METHODS: Consecutive non-valvular AF patients who underwent ECV were recruited. Major bleeding episodes and mortality were recorded. Factors associated with both endpoints and the predictive value of the HAS-BLED score were analysed.RESULTS: 406 patients (281 males; age 66.9±10.9years) undergoing 571 ECV were included. After a follow-up of nearly 3years, 20 patients presented with major bleeding (1.9%/year;) and 26 patients died (2.4%/year). The HAS-BLED score predicted both major bleeding [c-statistics: 0.77; 95%CI: 0.71-0.83; p<0.001] and mortality [c-statistics: 0.83; 95%CI: 0.79-0.87; p<0.001]. Variables associated with bleeding were: renal impairment (HR: 4.35; 95%CI: 1.22-15.52; p=0.02), poor quality anticoagulation (HR: 3.21; 95%CI: 1.11-9.32; p=0.03), previous bleeding-predisposition (HR: 5.43; 95%CI: 1.76-16.75; p=0.003) and the HAS-BLED score (HR: 1.88; 95%CI: 1.34-2.64; p<0.001). Factors associated with mortality were: age (HR: 1.08; 95%CI: 1.03-1.14; p=0.004), poor quality anticoagulation (HR: 3.11; 95%CI: 1.15-8.36; p=0.02), previous bleeding-predisposition (HR: 5.90; 95%CI: 1.41-24.65; p=0.01), liver impairment (HR: 9.27; 95%CI:1.64-52.34; p=0.01), the CHA2DS2-VASc score (HR: 1.63; 95%CI: 1.18-2.26; p=0.003) and the HAS-BLED score (HR: 2.74; 95%CI: 1.86-4.04); p<0.001).CONCLUSIONS: In AF patients undergoing ECV, major bleeding episodes and mortality were independently associated with poor quality anticoagulation control and previous bleeding-predisposition. The HAS-BLED score successfully predicted major bleeding and mortality.

AB - BACKGROUND: Atrial fibrillation (AF) patients eligible for cardioversion tend to be younger and are at lower risk than 'general' AF clinic populations. We evaluated the incidence of major bleeding and death, as well as the predictive value of the HAS-BLED score in non-valvular AF patients who underwent electrical cardioversion (ECV).METHODS: Consecutive non-valvular AF patients who underwent ECV were recruited. Major bleeding episodes and mortality were recorded. Factors associated with both endpoints and the predictive value of the HAS-BLED score were analysed.RESULTS: 406 patients (281 males; age 66.9±10.9years) undergoing 571 ECV were included. After a follow-up of nearly 3years, 20 patients presented with major bleeding (1.9%/year;) and 26 patients died (2.4%/year). The HAS-BLED score predicted both major bleeding [c-statistics: 0.77; 95%CI: 0.71-0.83; p<0.001] and mortality [c-statistics: 0.83; 95%CI: 0.79-0.87; p<0.001]. Variables associated with bleeding were: renal impairment (HR: 4.35; 95%CI: 1.22-15.52; p=0.02), poor quality anticoagulation (HR: 3.21; 95%CI: 1.11-9.32; p=0.03), previous bleeding-predisposition (HR: 5.43; 95%CI: 1.76-16.75; p=0.003) and the HAS-BLED score (HR: 1.88; 95%CI: 1.34-2.64; p<0.001). Factors associated with mortality were: age (HR: 1.08; 95%CI: 1.03-1.14; p=0.004), poor quality anticoagulation (HR: 3.11; 95%CI: 1.15-8.36; p=0.02), previous bleeding-predisposition (HR: 5.90; 95%CI: 1.41-24.65; p=0.01), liver impairment (HR: 9.27; 95%CI:1.64-52.34; p=0.01), the CHA2DS2-VASc score (HR: 1.63; 95%CI: 1.18-2.26; p=0.003) and the HAS-BLED score (HR: 2.74; 95%CI: 1.86-4.04); p<0.001).CONCLUSIONS: In AF patients undergoing ECV, major bleeding episodes and mortality were independently associated with poor quality anticoagulation control and previous bleeding-predisposition. The HAS-BLED score successfully predicted major bleeding and mortality.

U2 - 10.1016/j.ijcard.2016.04.167

DO - 10.1016/j.ijcard.2016.04.167

M3 - Journal article

C2 - 27179207

SN - 0167-5273

VL - 217

SP - 42

EP - 48

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

The HAS-BLED score predicts long-term major bleeding and death in anticoagulated non-valvular atrial fibrillation patients undergoing electrical cardioversion

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