AMADEUS: Are New Stroke and Bleeding Risk Scores for AFib Patients Better Than Traditional Models?
Sep 03, 2013
ACC News Story
"I think the key message is, risk stratify those atrial fibrillation patients not only for their thromboembolic risk but also their bleeding risk, using their existent scores," said Deepak Bhatt, MD, FACC.
Two new composite risk prediction scores for stroke or bleeding in patients with atrial fibrillation (AFib), while offering good discriminatory and predictive performance, did not perform much better than the "easier" and "more traditional" stroke and bleeding risk scores currently in use, according to results from the AMADEUS Study presented as part of the ESC Congress 2013 in Amsterdam.
Using data from the vitamin K antagonist arm of the AMADEUS Trial, investigators created two composite endpoints: stroke/thromboembolism plus major bleeding; and stroke, systemic or venous embolism, MI, cardiovascular death (CVD) or major bleeding. The endpoints were validated in a cohort of 441 AFib patients receiving antithrombotic therapy.
Independent predictors of the stroke/thromboembolism/major bleeding endpoint were age, previous stroke/transient ischemic attack, aspirin use and time in therapeutic range. For the stroke/systemic or venous embolism/MI/CVD/major bleeding composite, independent predictors were the same plus left ventricular dysfunction. As compared to the CHADS2, CHADS2-VASc and HAS-BLED risk indexes, both of the new models demonstrated greater discriminatory power, but there was no statistically significant difference in the net reclassification improvement.
As a result of the findings, the study investigators suggest continued use of the CHADS2-VASc and HAS-BLED risk scores, which they say allow for greater practically for everyday clinical practice and more personalized balancing of risks. "Simplicity is best," said Gregory YH Lip, MD, FACC, professor of cardiovascular medicine at the University of Birmingham, UK. "Assess stroke using CHADS2-VASc and assess bleeding risk with HAS-BLED."