PB0012 - Anticoagulant use and prognosis of non-valvular atrial fibrillation patients according to baseline CHA2DS2-VASc score and HAS-BLED score

Background: How CHA2DS2-VASc score and HAS-BLED score are associated with anticoagulation therapy and prognosis has not been examined in a large, recent, unselected non-valvular atrial fibrillation (NVAF) population.

Aims: To evaluate anticoagulant use and prognosis of NVAF patients stratified by baseline CHA2DS2-VASc score and HAS-BLED score.

Methods: Nationwide data from Statistics Netherlands were used to identify incident NVAF patients diagnosed between 2015 and 2019. Patients were followed for one year (or until death if it occurred earlier), and stratified by sex and categories of baseline CHA2DS2-VASc (i.e., 0, 1, ≥2) and HAS-BLED score (i.e., < 3, ≥3). Anticoagulant prescriptions and adverse clinical events (i.e., ischemic stroke and major bleeding) during follow-up were examined.

Results: 314,817 patients were included (74.6±11.9 years, 55.8% male). Within six months after the incident NVAF diagnosis, 75.2% received ≥1 anticoagulant, of whom 57.0% received direct oral anticoagulant as the first anticoagulant, and 38.7% received vitamin K antagonist. Fewer patients with a low CHA2DS2-VASc score (i.e., 0 for male, 1 for female) received anticoagulants than those with a higher CHA2DS2-VASc score (Table 1), while for patients with a high CHA2DS2-VASc score (i.e., ≥1 for male, ≥2 for female), anticoagulants were slightly less prescribed to patients with a high HAS-BLED score than those with a low HAS-BLED score. High baseline CHA2DS2-VASc score was associated with higher 1-year risk of ischemic stroke, which was more pronounced in those also with a high HAS-BLED score (Figure 1). Similarly, high HAS-BLED score was associated with major bleeding. Notably, the currently used cut-off of CHA2DS2-VASc score (i.e., 0-1 for male, 1 for female) well identified the patient population with a 1-year risk of ischemic stroke < 1%.

Conclusion(s): Anticoagulant prescription in the Netherlands in recent years was generally guided by the CHA2DS2-VASc score, which accurately identified the patient population with truly low ischemic stroke risk.