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.
authors.affiliation: Arrhythmia Unit, Cardiology Department, General University Hospital of Alicante, Spain.
authors.forename: Amaya
authors.initials: A
authors.lastname: García-Fernández
authors.affiliation: Department of Cardiology, Virgen de la Arrixaca University Hospital, University of Murcia, Spain. Electronic address: fcomarino@hotmail.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
authors.affiliation: Hematology and Medical Oncology Unit, Morales Meseguer University Hospital, University of Murcia, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Roldán
authors.affiliation: Arrhythmia Unit, Cardiology Department, General University Hospital of Alicante, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Galcerá-Jornet
authors.affiliation: Arrhythmia Unit, Cardiology Department, General University Hospital of Alicante, Spain.
authors.forename: Juan Gabriel
authors.initials: JG
authors.lastname: Martínez-Martínez
authors.affiliation: Department of Cardiology, Virgen de la Arrixaca University Hospital, University of Murcia, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
authors.affiliation: Arrhythmia Unit, Cardiology Department, General University Hospital of Alicante, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sogorb
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000401:mortality* / Q000628:therapy*; D004554:Electric Countershock / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; Electrical cardioversion; HAS-BLED; Haemorrhage; Mortality; Risk factors