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External Validation of HASBLED and ORBIT bleeding risk scores in Wales-AF population

Fatemeh Torabi Orcid Logo, D Harris, Arron Lacey Orcid Logo, Ashley Akbari Orcid Logo, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo, Daniel Harris

European Heart Journal, Volume: 44, Issue: Supplement_2

Swansea University Authors: Fatemeh Torabi Orcid Logo, Arron Lacey Orcid Logo, Ashley Akbari Orcid Logo, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo, Daniel Harris

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DOI (Published version): 10.1093/eurheartj/ehad655.2450

Abstract

BackgroundAnticoagulant therapy (AC) is recommended for Atrial Fibrillation (AF) patients when formal assessment of thromboembolic and bleeding risk suggests a net benefit of AC treatment. Recent UK National Institute of Health and Care Excellence guidelines consider that the ORBIT bleeding risk sco...

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Published in: European Heart Journal
ISSN: 0195-668X 1522-9645
Published: Oxford University Press (OUP) 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa65171
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Recent UK National Institute of Health and Care Excellence guidelines consider that the ORBIT bleeding risk score(1) provides a more accurate assessment of bleeding risk with AC than the HASBLED score(2) and is recommended for routine clinical use in the UK.PurposeTo compare the performance of HASBLED and ORBIT scores to predict hospitalisations for bleeding (HB) in a large population of UK patients with AF receiving AC.MethodsWe conducted a retrospective longitudinal analysis using linked primary and secondary care health records in the All-Wales SAIL databank. Patients with a diagnosis of AF treated with AC were identified between 2012 and 2018. Both HASBLED and ORBIT scores were calculated for each patient annually based on identified comorbidities, demographics and prescription data. All HB were evaluated. Logistic regression models were used to compare sensitivity and specificity of each score for HB prediction. The Area Under Curve for the Receiver operating Characteristic plot (AUC) was generated for each score to illustrate the risk discrimination ability of each prediction schemes.ResultsA total of 107,137 (45% female, mean age=74) AF patients were evaluated over the study period. The number of anticoagulated AF patients increased from 27,959 in 2012 (49.3% of cohort) to 48,595 in 2018 (66.8%), providing a total of 265,410 patient years of AC therapy for analysis. There were 710 HB (2.5% of AC patients) in 2012 increasing to 1,146 (2.4%) in 2018. The predictive power of HASBLED and ORBIT increased slightly over the period of study: with observed HASBLED AUC of 60.8 and ORBIT AUC of 64.8 in 2018 (Figure 1). Over the period of study, the observed HB rates for AC AF patients with HAS BLED scores of 0-3 and ORBIT scores of 0-5 were similar to those observed in the original studies, but observed HB for patients with higher HASBLED and ORBIT scores were less consistent (Fig. 2)ConclusionOur findings demonstrated that HASBLED and ORBIT were relatively limited in their predictive performance for HB in a large, real-world AC AF population, with ORBIT providing more accurate prediction across the overall risk range. This highlights the need to develop and validate new bleeding risk scores from the wide range of clinical and demographic factors in AF patients to improve effectiveness of risk communication and AC prescribing in AF.</abstract><type>Journal Article</type><journal>European Heart Journal</journal><volume>44</volume><journalNumber>Supplement_2</journalNumber><paginationStart/><paginationEnd/><publisher>Oxford University Press (OUP)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0195-668X</issnPrint><issnElectronic>1522-9645</issnElectronic><keywords>anticoagulation, atrial fibrillation, thromboembolism, hemorrhage, area under curve, comorbidity, demography, hospitalization, roc curve, country of wales, diagnosis, guidelines, orbit, prescribing behavior, secondary care, risk of excessive or recurrent bleeding, risk communication</keywords><publishedDay>9</publishedDay><publishedMonth>11</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-11-09</publishedDate><doi>10.1093/eurheartj/ehad655.2450</doi><url>http://dx.doi.org/10.1093/eurheartj/ehad655.2450</url><notes>Free to read from publisher website.</notes><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm/><funders/><projectreference/><lastEdited>2024-03-25T14:47:36.0898779</lastEdited><Created>2023-12-01T09:52:47.3701188</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>1</order></author><author><firstname>D</firstname><surname>Harris</surname><order>2</order></author><author><firstname>Arron</firstname><surname>Lacey</surname><orcid>0000-0001-7983-8073</orcid><order>3</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>4</order></author><author><firstname>Michael</firstname><surname>Gravenor</surname><orcid>0000-0003-0710-0947</orcid><order>5</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>6</order></author><author><firstname>Daniel</firstname><surname>Harris</surname><order>7</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2024-03-25T14:47:36.0898779 v2 65171 2023-12-01 External Validation of HASBLED and ORBIT bleeding risk scores in Wales-AF population f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false b69d245574e754d2637cc9e76379fe11 0000-0001-7983-8073 Arron Lacey Arron Lacey true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 70a544476ce62ba78502ce463c2500d6 0000-0003-0710-0947 Michael Gravenor Michael Gravenor true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false e60c9c73b645f0e8033ae26fa8e634b8 Daniel Harris Daniel Harris true false 2023-12-01 MEDS BackgroundAnticoagulant therapy (AC) is recommended for Atrial Fibrillation (AF) patients when formal assessment of thromboembolic and bleeding risk suggests a net benefit of AC treatment. Recent UK National Institute of Health and Care Excellence guidelines consider that the ORBIT bleeding risk score(1) provides a more accurate assessment of bleeding risk with AC than the HASBLED score(2) and is recommended for routine clinical use in the UK.PurposeTo compare the performance of HASBLED and ORBIT scores to predict hospitalisations for bleeding (HB) in a large population of UK patients with AF receiving AC.MethodsWe conducted a retrospective longitudinal analysis using linked primary and secondary care health records in the All-Wales SAIL databank. Patients with a diagnosis of AF treated with AC were identified between 2012 and 2018. Both HASBLED and ORBIT scores were calculated for each patient annually based on identified comorbidities, demographics and prescription data. All HB were evaluated. Logistic regression models were used to compare sensitivity and specificity of each score for HB prediction. The Area Under Curve for the Receiver operating Characteristic plot (AUC) was generated for each score to illustrate the risk discrimination ability of each prediction schemes.ResultsA total of 107,137 (45% female, mean age=74) AF patients were evaluated over the study period. The number of anticoagulated AF patients increased from 27,959 in 2012 (49.3% of cohort) to 48,595 in 2018 (66.8%), providing a total of 265,410 patient years of AC therapy for analysis. There were 710 HB (2.5% of AC patients) in 2012 increasing to 1,146 (2.4%) in 2018. The predictive power of HASBLED and ORBIT increased slightly over the period of study: with observed HASBLED AUC of 60.8 and ORBIT AUC of 64.8 in 2018 (Figure 1). Over the period of study, the observed HB rates for AC AF patients with HAS BLED scores of 0-3 and ORBIT scores of 0-5 were similar to those observed in the original studies, but observed HB for patients with higher HASBLED and ORBIT scores were less consistent (Fig. 2)ConclusionOur findings demonstrated that HASBLED and ORBIT were relatively limited in their predictive performance for HB in a large, real-world AC AF population, with ORBIT providing more accurate prediction across the overall risk range. This highlights the need to develop and validate new bleeding risk scores from the wide range of clinical and demographic factors in AF patients to improve effectiveness of risk communication and AC prescribing in AF. Journal Article European Heart Journal 44 Supplement_2 Oxford University Press (OUP) 0195-668X 1522-9645 anticoagulation, atrial fibrillation, thromboembolism, hemorrhage, area under curve, comorbidity, demography, hospitalization, roc curve, country of wales, diagnosis, guidelines, orbit, prescribing behavior, secondary care, risk of excessive or recurrent bleeding, risk communication 9 11 2023 2023-11-09 10.1093/eurheartj/ehad655.2450 http://dx.doi.org/10.1093/eurheartj/ehad655.2450 Free to read from publisher website. COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University 2024-03-25T14:47:36.0898779 2023-12-01T09:52:47.3701188 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Fatemeh Torabi 0000-0002-5853-4625 1 D Harris 2 Arron Lacey 0000-0001-7983-8073 3 Ashley Akbari 0000-0003-0814-0801 4 Michael Gravenor 0000-0003-0710-0947 5 Julian Halcox 0000-0001-6926-2947 6 Daniel Harris 7
title External Validation of HASBLED and ORBIT bleeding risk scores in Wales-AF population
spellingShingle External Validation of HASBLED and ORBIT bleeding risk scores in Wales-AF population
Fatemeh Torabi
Arron Lacey
Ashley Akbari
Michael Gravenor
Julian Halcox
Daniel Harris
title_short External Validation of HASBLED and ORBIT bleeding risk scores in Wales-AF population
title_full External Validation of HASBLED and ORBIT bleeding risk scores in Wales-AF population
title_fullStr External Validation of HASBLED and ORBIT bleeding risk scores in Wales-AF population
title_full_unstemmed External Validation of HASBLED and ORBIT bleeding risk scores in Wales-AF population
title_sort External Validation of HASBLED and ORBIT bleeding risk scores in Wales-AF population
author_id_str_mv f569591e1bfb0e405b8091f99fec45d3
b69d245574e754d2637cc9e76379fe11
aa1b025ec0243f708bb5eb0a93d6fb52
70a544476ce62ba78502ce463c2500d6
3676f695eeda169d0f8c618adf27c04b
e60c9c73b645f0e8033ae26fa8e634b8
author_id_fullname_str_mv f569591e1bfb0e405b8091f99fec45d3_***_Fatemeh Torabi
b69d245574e754d2637cc9e76379fe11_***_Arron Lacey
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
70a544476ce62ba78502ce463c2500d6_***_Michael Gravenor
3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
e60c9c73b645f0e8033ae26fa8e634b8_***_Daniel Harris
author Fatemeh Torabi
Arron Lacey
Ashley Akbari
Michael Gravenor
Julian Halcox
Daniel Harris
author2 Fatemeh Torabi
D Harris
Arron Lacey
Ashley Akbari
Michael Gravenor
Julian Halcox
Daniel Harris
format Journal article
container_title European Heart Journal
container_volume 44
container_issue Supplement_2
publishDate 2023
institution Swansea University
issn 0195-668X
1522-9645
doi_str_mv 10.1093/eurheartj/ehad655.2450
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
url http://dx.doi.org/10.1093/eurheartj/ehad655.2450
document_store_str 0
active_str 0
description BackgroundAnticoagulant therapy (AC) is recommended for Atrial Fibrillation (AF) patients when formal assessment of thromboembolic and bleeding risk suggests a net benefit of AC treatment. Recent UK National Institute of Health and Care Excellence guidelines consider that the ORBIT bleeding risk score(1) provides a more accurate assessment of bleeding risk with AC than the HASBLED score(2) and is recommended for routine clinical use in the UK.PurposeTo compare the performance of HASBLED and ORBIT scores to predict hospitalisations for bleeding (HB) in a large population of UK patients with AF receiving AC.MethodsWe conducted a retrospective longitudinal analysis using linked primary and secondary care health records in the All-Wales SAIL databank. Patients with a diagnosis of AF treated with AC were identified between 2012 and 2018. Both HASBLED and ORBIT scores were calculated for each patient annually based on identified comorbidities, demographics and prescription data. All HB were evaluated. Logistic regression models were used to compare sensitivity and specificity of each score for HB prediction. The Area Under Curve for the Receiver operating Characteristic plot (AUC) was generated for each score to illustrate the risk discrimination ability of each prediction schemes.ResultsA total of 107,137 (45% female, mean age=74) AF patients were evaluated over the study period. The number of anticoagulated AF patients increased from 27,959 in 2012 (49.3% of cohort) to 48,595 in 2018 (66.8%), providing a total of 265,410 patient years of AC therapy for analysis. There were 710 HB (2.5% of AC patients) in 2012 increasing to 1,146 (2.4%) in 2018. The predictive power of HASBLED and ORBIT increased slightly over the period of study: with observed HASBLED AUC of 60.8 and ORBIT AUC of 64.8 in 2018 (Figure 1). Over the period of study, the observed HB rates for AC AF patients with HAS BLED scores of 0-3 and ORBIT scores of 0-5 were similar to those observed in the original studies, but observed HB for patients with higher HASBLED and ORBIT scores were less consistent (Fig. 2)ConclusionOur findings demonstrated that HASBLED and ORBIT were relatively limited in their predictive performance for HB in a large, real-world AC AF population, with ORBIT providing more accurate prediction across the overall risk range. This highlights the need to develop and validate new bleeding risk scores from the wide range of clinical and demographic factors in AF patients to improve effectiveness of risk communication and AC prescribing in AF.
published_date 2023-11-09T05:31:10Z
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