Can Afib pattern determine bleeding risk among patients with heart failure?

Takeaway

• Among patients with heart failure (HF), sustained atrial fibrillation (Afib) was found to be associated with increased risk for anticoagulation-related bleeding outcomes.
• HAS-BLED scores which include data on the age, history of bleeding and Afib pattern, can help in risk prediction for clinically relevant bleeding in patients with Afib.

Why this matters

• Not much is known to postulate if the pattern of Afib predicts the incidence of clinically relevant bleeding events as bleeding can increase the economic burden on patients receiving anticoagulation therapy.

Study design

• Analysis of a prospective cohort study thrombEVAL including 1089 patients (paroxysmal Afib, n=398; sustained Afib, n=691) with Afib.
• Funding: Federal Ministry of Education and Research, Germany; and others.

Key results

• Sustained Afib group showed a significantly increased risk for clinically relevant bleeding (HR, 1.40; 95% CI, 1.02-1.93; P=.038) vs paroxysmal Afib group.
• Significant interaction was observed between sustained Afib group and heart failure resulting in clinically relevant bleeding (HR, 2.452; 95% CI, 1.512-3.978; P_interaction=.0019).
• Presence of sustained Afib doubled the risk for major bleeding in patients with HF (HR, 2.25; 95% CI, 1.26-4.02; P=.006).
• Discriminative ability for clinically relevant bleeding showed a significant improvement with simplified HAS-BLED score compared to original (area under curve [AUC]_HAS-BLED, 0.583 vs AUC _{HAS-BLED+Afib-type}, 0.606; P=.003).

Limitations

• Risk of misclassification of Afib patterns.