Enhancing the ‘real world’ prediction of cardiovascular events and major bleeding with the CHA<sub>2</sub>DS<sub>2</sub>-VASc and HAS-BLED scores using multiple biomarkers
Creators: name: Roldán, Vanessa
name: Rivera-Caravaca, José Miguel
name: Shantsila, Alena
name: García-Fernández, Amaya
name: Esteve-Pastor, María Asunción
name: Vilchez, Juan Antonio
name: Romera, Marta
name: Valdés, Mariano
name: Vicente, Vicente
name: Marín, Francisco
name: Lip, Gregory Y. H.
Publisher: name: Taylor & Francis
Year: 2017
Subjects: subject: Medicine
subject: Cell Biology
subject: Pharmacology
subject: 19999 Mathematical Sciences not elsewhere classified
subject: FOS: Mathematics
subject: FOS: Mathematics
subject: Hematology

description: <b>Background:</b> Atrial fibrillation (AF)-European guidelines suggest the use of biomarkers to stratify patients for stroke and bleeding risks. We investigated if a multibiomarker strategy improved the predictive performance of CHA<sub>2</sub>DS<sub>2</sub>-VASc and HAS-BLED in anticoagulated AF patients. <b>Methods:</b> We included consecutive patients stabilized for six months on vitamin K antagonists (INRs 2.0–3.0). High sensitivity troponin T, NT-proBNP, interleukin-6, von Willebrand factor concentrations and glomerular filtration rate (eGFR; using MDRD-4 formula) were quantified at baseline. Time in therapeutic range (TTR) was recorded at six months after inclusion. Patients were follow-up during a median of 2375 (IQR 1564–2887) days and all adverse events were recorded. <b>Results:</b> In 1361 patients, adding four blood biomarkers, TTR and MDRD-eGFR, the predictive value of CHA<sub>2</sub>DS<sub>2</sub>-VASc increased significantly by c-index (0.63 vs. 0.65; <i>p</i> = .030) and IDI (0.85%; <i>p</i> p p <b>Conclusions:</b> Addition of biomarkers enhanced the predictive value of CHA<sub>2</sub>DS<sub>2</sub>-VASc and HAS-BLED, although the overall improvement was modest and the added predictive advantage over original scores was marginal.Key MessagesRecent atrial fibrillation (AF)-European guidelines for the first time suggest the use of biomarkers to stratify patients for stroke and bleeding risks, but their usefulness in real world for risk stratification is still questionable.In this cohort study involving 1361 AF patients optimally anticoagulated with vitamin K antagonists, adding high sensitivity troponin T, N-terminal pro-B-type natriuretic peptide, interleukin 6, von Willebrand factor, glomerular filtration rate (by the MDRD-4 formula) and time in therapeutic range, increased the predictive value of CHA<sub>2</sub>DS<sub>2</sub>-VASc for cardiovascular events, but not the predictive value of HAS-BLED for major bleeding. Reclassification analyses did not show improvement adding multiple biomarkers.Despite the improvement observed, the added predictive advantage is marginal and the clinical usefulness and net benefit over current clinical scores is lower. Recent atrial fibrillation (AF)-European guidelines for the first time suggest the use of biomarkers to stratify patients for stroke and bleeding risks, but their usefulness in real world for risk stratification is still questionable. In this cohort study involving 1361 AF patients optimally anticoagulated with vitamin K antagonists, adding high sensitivity troponin T, N-terminal pro-B-type natriuretic peptide, interleukin 6, von Willebrand factor, glomerular filtration rate (by the MDRD-4 formula) and time in therapeutic range, increased the predictive value of CHA<sub>2</sub>DS<sub>2</sub>-VASc for cardiovascular events, but not the predictive value of HAS-BLED for major bleeding. Reclassification analyses did not show improvement adding multiple biomarkers. Despite the improvement observed, the added predictive advantage is marginal and the clinical usefulness and net benefit over current clinical scores is lower.