Performance of CHA 2 DS 2 -VASc and HAS-BLED in predicting stroke and bleeding in atrial fibrillation and cancer

Ajabnoor, Alyaa M; Zghebi, Salwa S; Parisi, Rosa; Ashcroft, Darren M; Faivre-Finn, Corinne; Mamas, Mamas A; Kontopantelis, Evangelos

Abstract

Aims: To compare the predictive performance of CHA2DS2-VASc and HAS-BLED scores in atrial fibrillation (AF) patients with and without cancer. Methods and results: Using data from the Clinical Practice Research Datalink in England, we performed a retrospective cohort study of patients with new diagnoses of AF from 2009 to 2019. Cancer was defined as history of breast, prostate, colorectal, lung, or haematological cancer. We calculated the CHA2DS2-VASc and HAS-BLED scores for the 1-year risk of stroke and major bleeding events. Scores performance was estimated by discrimination [area under the receiver operating characteristic curve (AUC)] and calibration plots. Of 141 796 patients with AF, 10.3% had cancer. The CHA2DS2-VASc score had good to modest discrimination in prostate cancer AUC = 0.74 (95% confidence interval: 0.71, 0.77), haematological cancer AUC = 0.71 (0.66, 0.76), colorectal cancer AUC = 0.70 (0.66, 0.75), breast cancer AUC = 0.70 (0.66, 0.74), and lung cancer AUC = 0.69 (0.60, 0.79), compared with no-cancer AUC = 0.73 (0.72, 0.74). HAS-BLED discrimination was poor in prostate cancer AUC = 0.58 (0.55, 0.61), haematological cancer AUC = 0.59 (0.55, 0.64), colorectal cancer AUC = 0.57 (0.53, 0.61), breast cancer AUC = 0.56 (0.52, 0.61), and lung cancer AUC = 0.59 (0.51, 0.67), compared with no-cancer AUC = 0.61 (0.60, 0.62). Both the CHA2DS2-VASc score and HAS-BLED score were well calibrated across all study cohorts. Conclusion: Amongst certain cancer cohorts in the AF population, CHA2DS2-VASc performs similarly in predicting stroke to AF patients without cancer. Our findings highlight the importance of cancer diagnosis during the development of risk scores and opportunities to optimize the HAS-BLED risk score to better serve cancer patients with AF.

Citation

Ajabnoor, A. M., Zghebi, S. S., Parisi, R., Ashcroft, D. M., Faivre-Finn, C., Mamas, M. A., & Kontopantelis, E. (2024). Performance of CHA 2 DS 2 -VASc and HAS-BLED in predicting stroke and bleeding in atrial fibrillation and cancer. European Heart Journal Open, 4(4), Article oeae053. https://doi.org/10.1093/ehjopen/oeae053

• Journal Article Type: Article
• Acceptance Date: Jun 14, 2024
• Online Publication Date: Jun 26, 2024
• Publication Date: 2024-07
• Deposit Date: Jul 15, 2024
• Publicly Available Date: Jul 15, 2024
• Journal: European Heart Journal Open
• Print ISSN: 2752-4191
• Electronic ISSN: 2752-4191
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 4
• Issue: 4
• Article Number: oeae053
• DOI: https://doi.org/10.1093/ehjopen/oeae053
• Keywords: Atrial fibrillation, Cancer, Bleeding, Stroke, Risk assessment score, Oral anticoagulant
• Public URL: https://keele-repository.worktribe.com/output/875242
• Publisher URL: https://academic.oup.com/ehjopen/article/4/4/oeae053/7699772