Publication:
Enhancing the 'real world' prediction of cardiovascular events and major bleeding with the CHA2DS2-VASc and HAS-BLED scores using multiple biomarkers.

Simple item page
dc.contributor.authorRoldán Schilling, Vanessa
dc.contributor.authorRivera Caravaca, José Miguel
dc.contributor.authorShantsila, Alena
dc.contributor.authorGarcía Fernández, Amaya
dc.contributor.authorEsteve Pastor, Maria Asunción
dc.contributor.authorRomera García, Marta
dc.contributor.authorValdes Chavarri, Mariano
dc.contributor.authorVicente García, Vicente
dc.contributor.authorMarin Ortuño, Francisco
dc.contributor.authorLip, Gregory Y
dc.contributor.departmentMedicina
dc.date.accessioned2024-02-08T09:13:47Z
dc.date.available2024-02-08T09:13:47Z
dc.date.issued2018
dc.description©2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This document is the Published version of a Published Work that appeared in final form inAnnals of Medicine. To access the final edited and published work see https://doi.org/10.1080/07853890.2017.1378429es
dc.description.abstractBackground: 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 CHA2DS2-VASc and HAS-BLED in anticoagulated AF patients. Methods: 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. Results: In 1361 patients, adding four blood biomarkers, TTR and MDRD-eGFR, the predictive value of CHA2DS2-VASc increased significantly by c-index (0.63 vs. 0.65; p = .030) and IDI (0.85%; p < .001), but not by NRI (-2.82%; p < .001). The predictive value of HAS-BLED increased up to 1.34% by IDI (p < .001). Nevertheless, the overall predictive value remains modest (c-indexes approximately 0.65) and decision curve analyses found lower net benefit compared with the originals scores. Conclusions: Addition of biomarkers enhanced the predictive value of CHA2DS2-VASc and HAS-BLED, although the overall improvement was modest and the added predictive advantage over original scores was marginal. Key Messages 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 CHA2DS2-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.es
dc.formatapplication/pdfes
dc.format.extent10es
dc.identifier.citationAnnals of Medicine
dc.identifier.doi10.1080/07853890.2017.1378429
dc.identifier.issn1365-2060
dc.identifier.issn0785-3890
dc.identifier.urihttp://hdl.handle.net/10201/138958
dc.languageenges
dc.relationInstituto de Salud Carlos III(ISCIII), Fondo Europeo de Desarrollo Regional (FEDER) (PI13/00513 y P14/00253), Fundacion SENECA (19245/PI/14), e Instituto Murciano de InvestigacionBiosanitaria (IMIB16/AP/01/06).es
dc.rightsinfo:eu-repo/semantics/openAccesses
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internacional*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subjectfibrilacion auricular,es
dc.subjectictuses
dc.subjectbiomarcadores
dc.subjecthemorragiaes
dc.titleEnhancing the 'real world' prediction of cardiovascular events and major bleeding with the CHA2DS2-VASc and HAS-BLED scores using multiple biomarkers.es
dc.typeinfo:eu-repo/semantics/articlees
dspace.entity.typePublicationes
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Enhancing the real world prediction of cardiovascular events and major bleeding with the CHA2DS2-VASc and HAS-BLED scores using multiple biomarkers.pdf
Size:
1.73 MB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
2.26 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Artículos