Evaluating the effects of socioeconomic status on stroke and bleeding risk scores and clinical events in patients on oral anticoagulant for new onset atrial fibrillation.

Kourosh Ravvaz,John A Weissert,Arshad Jahangir,Christian T Ruff,Aristeidis H Katsanos

doi:10.1371/journal.pone.0248134

Abstract

BackgroundThe 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 findingsThe 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.ConclusionADI can predict increased risk for ischemic and bleeding events in the first year of warfarin therapy in patients with incident AF.

Highlights

Atrial Fibrillation (AF), the most common heart arrhythmia, affects about 6.1 million American adults, and that number is expected to double over the 25 years [1,2]
CR is a member of the TIMI Study Group, which has received institutional research grant support unrelated to this study through Brigham and Women’s Hospital from Abbott, Amgen, Anthos Therapeutics, AstraZeneca, Bayer HealthCare Pharmaceuticals, Inc., Daiichi-Sankyo, Eisai, Intarcia, MedImmune, Merck, Novartis, Pfizer, Quark Pharmaceuticals, Regeneron Pharmaceuticals, Inc., Roche, Siemens Healthcare Diagnostics, Inc., The Medicines Company, and Zora Biosciences
The objective of this study was to evaluate the impact of socioeconomic status (SES), measured by area deprivation index (ADI), on patients’ risk of stroke and bleeding as determined by commonly used CHA2DS2-VASc, and HASBLED risk scores in newly diagnosed AF patients started on warfarin therapy

Summary

Introduction

Atrial Fibrillation (AF), the most common heart arrhythmia, affects about 6.1 million American adults, and that number is expected to double over the 25 years [1,2]. Oral anticoagulation (OAC) therapy effectively reduces stroke risk by more than 60% in patients with AF but at the cost of an increased risk of bleeding, including intracranial hemorrhage [4] In this light, CHA2DS2-VASc and HAS-BLED are the two most commonly used risk scores to help determine if OAC therapy will provide an overall net benefit for patients with AF [5]. After controlling for common risk factors, AF patients with lower educational attainment, lower-income, and higher age are all less likely to be prescribed OAC [10] This disproportionately prevents patients with lower socioeconomic status (SES) from receiving the benefits of this important therapy for secondary and primary stroke prevention. 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

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