Key result
Novel claims-based ICH risk model outperforms HAS-BLED in older adults with AF starting OAC.
Why the study?
High risk of intracranial hemorrhage is a leading reason for withholding anticoagulation in patients with atrial fibrillation.
Does a novel claims-based ICH risk prediction model improve the prediction of 1-year intracranial hemorrhage risk compared to HAS-BLED and Homer scores in older adults with atrial fibrillation initiating oral anticoagulation?
Cohort
Does a novel claims-based ICH risk prediction model improve the prediction of 1-year intracranial hemorrhage risk compared to HAS-BLED and Homer scores in older adults with atrial fibrillation initiating oral anticoagulation?
p-value: p=<0.001
A novel claims-based risk score outperforms the standard HAS-BLED score in predicting 1-year intracranial hemorrhage risk among older adults with atrial fibrillation starting oral anticoagulation.
May enhance claims-based ICH risk stratification over HAS-BLED in older AF patients; hypothesis-generating and requires prospective validation before practice change.
Background: High risk of intracranial hemorrhage (ICH) is a leading reason for withholding anticoagulation in patients with atrial fibrillation (AF). We aimed to develop a claims-based ICH risk prediction model in older adults with AF initiating oral anticoagulation (OAC). Methods: We used US Medicare claims data to identify new users of OAC aged ≥65 years with AF in 2010-2017. We used regularized Cox regression to select predictors of ICH. We compared our AF ICH risk score with the HAS-BLED bleed risk and Homer fall risk scores by area under the receiver operating characteristic curve (AUC) and assessed net reclassification improvement (NRI) when predicting 1-year risk of ICH. Results: <0.001). Conclusion: Our novel claims-based ICH risk prediction model outperformed the standard HAS-BLED score and can inform OAC prescribing decisions.
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Bessette et al. (2024) conducted a cohort in Atrial fibrillation. AF ICH risk score vs. HAS-BLED and Homer fall risk scores was evaluated on 1-year risk of intracranial hemorrhage (ICH) (p=<0.001). A novel claims-based intracranial hemorrhage risk prediction model outperformed the standard HAS-BLED score in older adults with atrial fibrillation initiating oral anticoagulation (P<0.001).
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