The HAS-BLED score predicts long-term major bleeding and death in anticoagulated non-valvular atrial fibrillation patients undergoing electrical cardioversion. (15th August 2016)

• Record Type: Journal Article
• Authors: García-Fernández, Amaya; Marín, Francisco; Roldán, Vanessa; Galcerá-Jornet, Emilio; Martínez-Martínez, Juan Gabriel; Valdés, Mariano; Sogorb, Francisco; Lip, Gregory Y.H.
• Is Part Of: International journal of cardiology. Volume 217(2016)
• Page Start: 42
• Page End: 48
• Publication Date: 2016-08-15
• Subjects: Atrial fibrillation -- Electrical cardioversion -- Haemorrhage -- Mortality -- Risk factors -- HAS-BLED; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.04.167
• Languages: English
• ISSNs: 0167-5273

Abstract

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 ± 10.9 years) undergoing 571 ECV were included. After a follow-up of nearly 3 years, 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 CHA2 DS2 -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.