Little is known about the prediction of atrial fibrillation (AF) risk scores in patients
with cancer. The aim of this study was to assess the predictive ability of the CHA2DS2-VASc and HAS-BLED scores in patients with AF and cancer. Overall, 16,056 patients
with AF diagnosed between 2014 and 2018 from a Spanish health area, including 1,137
patients with cancer, were observed during a median follow-up of 4.9 years. Although
discrimination was similar between patients with cancer and patients without cancer
who were treated with anticoagulation therapy (0.56 and 0.58), in patients with cancer
who were not treated with anticoagulation therapy, c-statistic of CHA2DS2-VASc was poor and significantly lower than in the patients without cancer (0.42 vs
0.65). The overall precision of the CHA2DS2-VASc score was good throughout the follow-up (Brier score < 0.1), in patients with
and without cancer. Regarding the HAS-BLED score, calibration and discrimination were
poor in patients with cancer (c-statistic 0.51), similar to those in patients without
cancer (c-statistic 0.53). In patients with cancer who were not treated with anticoagulation
therapy, the embolic risk CHA2DS2-VASc score = 1 was similar to CHA2DS2-VASc score ≥ 2. Only patients with AF and cancer and CHA2DS2-VASc score = 0 presented a low risk of embolic events (negative predictive value
100%). A HAS-BLED score > 3 was not associated with higher bleeding risk in patients
with cancer (p > 0.05). In summary, in patients with cancer and with AF, neither the
CHA2DS2-VASc score nor the HAS-BLED score was useful for predicting embolic and hemorrhagic
events, respectively. However, a CHA2DS2-VASc score 0 is useful to identify patients with AF and cancer who are at low embolic
risk.
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Article Info
Publication History
Published online: July 29, 2022
Received in revised form:
June 18,
2022
Received:
March 24,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The electronic registry was funded in a nonconditioned way by Daiichi Sankyo, Pfizer-BMS, Bayer, and Boehringer Ingelheim. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
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© 2022 Published by Elsevier Inc.
