PDF(Pubmed)
Abstract：
UNASSIGNED: To compare the predictive performance of CHA2DS2-VASc and HAS-BLED scores in atrial fibrillation (AF) patients with and without cancer.
UNASSIGNED: Using data from the Clinical Practice Research Datalink in England, we performed a retrospective cohort study of patients with new diagnoses of AF from 2009 to 2019. Cancer was defined as history of breast, prostate, colorectal, lung, or haematological cancer. We calculated the CHA2DS2-VASc and HAS-BLED scores for the 1-year risk of stroke and major bleeding events. Scores performance was estimated by discrimination [area under the receiver operating characteristic curve (AUC)] and calibration plots. Of 141 796 patients with AF, 10.3% had cancer. The CHA2DS2-VASc score had good to modest discrimination in prostate cancer AUC = 0.74 (95% confidence interval: 0.71, 0.77), haematological cancer AUC = 0.71 (0.66, 0.76), colorectal cancer AUC = 0.70 (0.66, 0.75), breast cancer AUC = 0.70 (0.66, 0.74), and lung cancer AUC = 0.69 (0.60, 0.79), compared with no-cancer AUC = 0.73 (0.72, 0.74). HAS-BLED discrimination was poor in prostate cancer AUC = 0.58 (0.55, 0.61), haematological cancer AUC = 0.59 (0.55, 0.64), colorectal cancer AUC = 0.57 (0.53, 0.61), breast cancer AUC = 0.56 (0.52, 0.61), and lung cancer AUC = 0.59 (0.51, 0.67), compared with no-cancer AUC = 0.61 (0.60, 0.62). Both the CHA2DS2-VASc score and HAS-BLED score were well calibrated across all study cohorts.
UNASSIGNED: Amongst certain cancer cohorts in the AF population, CHA2DS2-VASc performs similarly in predicting stroke to AF patients without cancer. Our findings highlight the importance of cancer diagnosis during the development of risk scores and opportunities to optimize the HAS-BLED risk score to better serve cancer patients with AF.
UNASSIGNED: Using data from the Clinical Practice Research Datalink in England, we performed a retrospective cohort study of patients with new diagnoses of AF from 2009 to 2019. Cancer was defined as history of breast, prostate, colorectal, lung, or haematological cancer. We calculated the CHA2DS2-VASc and HAS-BLED scores for the 1-year risk of stroke and major bleeding events. Scores performance was estimated by discrimination [area under the receiver operating characteristic curve (AUC)] and calibration plots. Of 141 796 patients with AF, 10.3% had cancer. The CHA2DS2-VASc score had good to modest discrimination in prostate cancer AUC = 0.74 (95% confidence interval: 0.71, 0.77), haematological cancer AUC = 0.71 (0.66, 0.76), colorectal cancer AUC = 0.70 (0.66, 0.75), breast cancer AUC = 0.70 (0.66, 0.74), and lung cancer AUC = 0.69 (0.60, 0.79), compared with no-cancer AUC = 0.73 (0.72, 0.74). HAS-BLED discrimination was poor in prostate cancer AUC = 0.58 (0.55, 0.61), haematological cancer AUC = 0.59 (0.55, 0.64), colorectal cancer AUC = 0.57 (0.53, 0.61), breast cancer AUC = 0.56 (0.52, 0.61), and lung cancer AUC = 0.59 (0.51, 0.67), compared with no-cancer AUC = 0.61 (0.60, 0.62). Both the CHA2DS2-VASc score and HAS-BLED score were well calibrated across all study cohorts.
UNASSIGNED: Amongst certain cancer cohorts in the AF population, CHA2DS2-VASc performs similarly in predicting stroke to AF patients without cancer. Our findings highlight the importance of cancer diagnosis during the development of risk scores and opportunities to optimize the HAS-BLED risk score to better serve cancer patients with AF.
摘要：
■比较CHA2DS2-VASc和HAS-BLED评分在有和没有癌症的房颤（AF）患者中的预测性能。
■使用英国临床实践研究数据链的数据，我们对2009年至2019年新诊断为AF的患者进行了回顾性队列研究.癌症被定义为乳腺病史，前列腺,结直肠,肺，或者血液癌症。我们计算了CHA2DS2-VASc和HAS-BLED的1年卒中和大出血事件风险评分。通过辨别[接收器工作特征曲线(AUC)下的面积]和校准图来估计分数性能。在141796例房颤患者中，10.3%患有癌症。CHA2DS2-VASc评分在前列腺癌AUC=0.74（95％置信区间：0.71，0.77）中具有良好到适度的区分，血液癌症AUC=0.71（0.66，0.76），结直肠癌AUC=0.70（0.66，0.75），乳腺癌AUC=0.70（0.66，0.74），肺癌AUC=0.69（0.60，0.79），与非癌症相比，AUC=0.73（0.72，0.74）。在前列腺癌AUC=0.58（0.55，0.61）中，HAS-BLED辨别能力较差，血液癌症AUC=0.59（0.55，0.64），结直肠癌AUC=0.57（0.53，0.61），乳腺癌AUC=0.56（0.52，0.61），肺癌AUC=0.59（0.51，0.67），与非癌症AUC=0.61（0.60，0.62）。在所有研究队列中，CHA2DS2-VASc评分和HAS-BLED评分都得到了很好的校准。
■在房颤人群中的某些癌症队列中，CHA2DS2-VASc在预测无癌症的AF患者的中风方面表现相似。我们的研究结果强调了在风险评分和优化HAS-BLED风险评分以更好地为患有AF的癌症患者提供服务的机会的发展过程中癌症诊断的重要性。
■使用英国临床实践研究数据链的数据，我们对2009年至2019年新诊断为AF的患者进行了回顾性队列研究.癌症被定义为乳腺病史，前列腺,结直肠,肺，或者血液癌症。我们计算了CHA2DS2-VASc和HAS-BLED的1年卒中和大出血事件风险评分。通过辨别[接收器工作特征曲线(AUC)下的面积]和校准图来估计分数性能。在141796例房颤患者中，10.3%患有癌症。CHA2DS2-VASc评分在前列腺癌AUC=0.74（95％置信区间：0.71，0.77）中具有良好到适度的区分，血液癌症AUC=0.71（0.66，0.76），结直肠癌AUC=0.70（0.66，0.75），乳腺癌AUC=0.70（0.66，0.74），肺癌AUC=0.69（0.60，0.79），与非癌症相比，AUC=0.73（0.72，0.74）。在前列腺癌AUC=0.58（0.55，0.61）中，HAS-BLED辨别能力较差，血液癌症AUC=0.59（0.55，0.64），结直肠癌AUC=0.57（0.53，0.61），乳腺癌AUC=0.56（0.52，0.61），肺癌AUC=0.59（0.51，0.67），与非癌症AUC=0.61（0.60，0.62）。在所有研究队列中，CHA2DS2-VASc评分和HAS-BLED评分都得到了很好的校准。
■在房颤人群中的某些癌症队列中，CHA2DS2-VASc在预测无癌症的AF患者的中风方面表现相似。我们的研究结果强调了在风险评分和优化HAS-BLED风险评分以更好地为患有AF的癌症患者提供服务的机会的发展过程中癌症诊断的重要性。
