Key result
High neighborhood deprivation is linked to increased major bleeding risk in incident AF patients on warfarin.
Why the study?
Socioeconomic status could influence thromboembolism and bleeding risks in AF, but its impact on the predictive performance of CHA2DS2-VASc and HAS-BLED scores remains unknown.
Does socioeconomic status defined by area deprivation index (ADI) predict ischemic and bleeding events in newly diagnosed atrial fibrillation patients treated with warfarin?
Cohort (n=7,274)
Yes
Does socioeconomic status defined by area deprivation index (ADI) predict ischemic and bleeding events in newly diagnosed atrial fibrillation patients treated with warfarin?
Socioeconomic status, measured by the Area Deprivation Index, significantly improves the prediction of ischemic events when added to the CHA2DS2-VASc score in patients with incident atrial fibrillation starting warfarin.
Answers are grounded in this paper and cite their sources.
Neighborhood deprivation signals higher warfarin bleeding risk in new AF; hypothesis-generating for ADI-enhanced stratification pending prospective validation.
BACKGROUND: The risk of thromboembolism and bleeding before initiation of oral anticoagulant (OAC) in atrial fibrillation patients is estimated by CHA2DS2-VASc and HAS-BLED scoring system, respectively. Patients' socioeconomic status (SES) could influence these risks, but its impact on the two risk scores' predictive performance with respect to clinical events remains unknown. Our objective was to determine if patient SES defined by area deprivation index (ADI), in conjunction with CHA2DS2-VASc and HAS-BLED scores, could guide oral anticoagulation therapy. METHODS AND FINDINGS: The study cohort included newly diagnosed patients with AF who were treated with warfarin. The cohort was stratified by the time in therapeutic range of INR (TTR), ADI, CHA2DS2-VASc, and HAS-BLED risk scores. TTR and ischemic and bleeding events during the first year of therapy were compared across subpopulations. Among 7274 patients, those living in the two most deprived quintiles (ADI ≥60%) had a significantly higher risk of ischemic events and those in the most deprived quintile (ADI≥80%) had a significantly increased risk of bleeding events. ADI significantly improved the predictive performance of CHA2DS2-VASc but not HAS-BLED risk scores. CONCLUSION: ADI can predict increased risk for ischemic and bleeding events in the first year of warfarin therapy in patients with incident AF.
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Ravvaz et al. (2021) conducted a cohort in New onset atrial fibrillation (n=7,274). High Area Deprivation Index (ADI ≥80%) vs. Lower Area Deprivation Index was evaluated on Major bleeding events (p=0.02). Patients with incident atrial fibrillation on warfarin living in the most socioeconomically deprived neighborhoods (ADI ≥80%) had a significantly increased risk of major bleeding events.
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