title: Predictive ability of HAS-BLED, HEMORR2HAGES, and ATRIA bleeding risk scores in patients with atrial fibrillation. A French nationwide cross-sectional study.
abstract: OBJECTIVE
  The HAS-BLED, ATRIA, and HEMORR2HAGES risk scores were created to evaluate individual bleeding risk in atrial fibrillation (AF). We sought to estimate and compare the predictive ability of these scores for major hemorrhage in AF, including elderly (≥80years) and non-elderly (<80years) patients.
  
  
  METHODS
  This cross-sectional study is based on the French National Hospital Database (PMSI), which covers the entire French population. Data from all patients with an AF diagnosis in 2012 were extracted. Demographic and comorbidity data were used to calculate the three bleeding risk scores for each patient. Patients hospitalized with a principal diagnosis of major bleeding were identified.
  
  
  RESULTS
  Of the 533,044 AF patients identified, 53.2% were ≥80years; 7013 patients (1.3%) were hospitalized for a bleeding event (1785 for intracranial hemorrhage). Bleeding occurred more frequently in patients with higher HAS-BLED, HEMORR2HAGES, and ATRIA scores. In patients ≥80years, the c-statistics did not differ (p=0.27) between HAS-BLED (0.54; 95% confidence interval [CI]: 0.53-0.54), HEMORR2HAGES (0.53; 95% CI: 0.53-0.54), and ATRIA (0.53; 95% CI: 0.52-0.54). In patients <80years, HAS-BLED (0.59; 95% CI: 0.58-0.60) had a slightly higher c-statistic than HEMORR2HAGES (0.56; 95% CI: 0.55-0.57) and ATRIA (0.55, 95% CI: 0.55-0.56) (p<0.0001).
  
  
  CONCLUSIONS
  Given its simplicity and similar performance, HAS-BLED may be an attractive alternative to HEMORR2HAGES for estimation of bleeding risk in AF patients <80years. However, accurate determination of bleeding risk among the elderly is difficult with existing risk-prediction scores, indicating a clear need for improvement in their clinical utility.
authors.affiliation: Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau, Tours 37044, France; Faculté de Médecine, Université François Rabelais, Tours 37032, France. Electronic address: lfau@med.univ-tours.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.affiliation: HEVA, Lyon, France.
authors.forename: Gwendoline
authors.initials: G
authors.lastname: Chaize
authors.affiliation: Bristol-Myers Squibb, Rueil-Malmaison, France.
authors.forename: Anne-Françoise
authors.initials: AF
authors.lastname: Gaudin
authors.affiliation: HEVA, Lyon, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Vainchtock
authors.affiliation: Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Sophie K
authors.initials: SK
authors.lastname: Rushton-Smith
authors.affiliation: Bristol-Myers Squibb, Rueil-Malmaison, France.
authors.forename: Francois-Emery
authors.initials: FE
authors.lastname: Cotté
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007297:Inpatients; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: Atrial fibrillation; Forecasting; Hemorrhage; Intracranial hemorrhages; Risk