Arrhythmias & electrophysiology
Association of CHA2DS2-VASc and HAS-BLED to frailty and frail outcomes: From the TREAT-AF study
Authors' conclusion
High CHA2DS2-VASc and HAS-BLED scores are strongly associated with frailty. However, in frail patients, OAC use was associated with reduction in 1-year mortality.
Study context
- Population
- Patients with newly diagnosed atrial fibrillation (AF), Veterans Health Administration (TREAT-AF), 2004–201498% male
- Participants
- 213,435 patients
- Exposure
- CHA2DS2-VASc and modified HAS-BLED scores vs frailty and frail events; Oral anticoagulant (OAC) use vs no OAC in frail patients
- Frailn = 8,498
- Outcome
- Frailty and a composite of noncardiovascular frail events (fractures, urinary tract infections, bacterial pneumonia or dehydration)
Main finding
As reported in the abstract
Frailty and noncardiovascular frail events by CHA2DS2-VASc and HAS-BLED
Estimate (95% CI)
CHA2DS2-VASc 4+frailty
OR 13.3(11.6–15.2)
HAS-BLED 3+frailty
OR 13.4(10.2–17.5)
CHA2DS2-VASc 4+non-CV frail events, adjusted
HR 2.1(2.0–2.2)
HAS-BLED 3+non-CV frail events, adjusted
HR 1.4(1.3–1.5)
Observational data: associations, not effects.
Further findings
OAC use in frail patients: 1-year mortality and stroke
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| OAC1-year mortality | 0.82 (0.72–0.94) | P = 0.0031 | |
| OACStroke | 0.80 (0.55–1.18) | P = 0.26 | |
| 0.512Hazard ratio (log scale) |
Safety
Major bleeding with OAC use in frail patients
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| OAC | 1.08 (0.93–1.25) | P = 0.34 | |
| 0.512Hazard ratio (log scale) |
Original publication
Association of CHA2DS2-VASc and HAS-BLED to frailty and frail outcomes: From the TREAT-AF study. Am Heart J. Published 5 April 2023. doi:10.
Summarised from the published abstract; every number is checked against it