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Discriminative Ability of CHA2DS2-VASc and HAS-BLED Score in Whites and Nonwhites

Sarah M Schwartz1, Yacob G Tedla1, Philip Greenland2

  • 1Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

The American Journal of Cardiology
|April 14, 2019
PubMed

Insights

Risk scores for atrial fibrillation (AF) stroke (CHA2DS2-VASc) and bleeding (HAS-BLED) performed similarly across racial groups in a US study. However, anticoagulation was less frequent in nonwhite patients despite comparable risk assessments.

Area of Science:

  • Cardiology
  • Clinical Epidemiology
  • Health Disparities

Background:

  • CHA2DS2-VASc and HAS-BLED scores predict stroke and bleeding risk in atrial fibrillation (AF).
  • These scores were developed in European populations and their performance in diverse US populations is understudied.
  • Understanding score performance across racial groups is crucial for equitable AF management.

Purpose of the Study:

  • To evaluate the discriminative ability of CHA2DS2-VASc and HAS-BLED scores in White and non-White patients with AF in the US.
  • To assess differences in anticoagulation prescription rates between racial groups.

Main Methods:

  • Retrospective cohort study of 21,648 AF patients from 2011-2017 in a US academic health system.
  • Cox proportional hazards models analyzed stroke risk (CHA2DS2-VASc) in non-anticoagulated patients and bleeding risk (HAS-BLED) in anticoagulated patients.
  • Analyses were stratified by race (White vs. non-White) and adjusted for baseline differences.

Main Results:

  • Oral anticoagulation was prescribed less frequently in non-White patients (46%) compared to White patients (52%) with CHA2DS2-VASc score ≥2.
  • Mean CHA2DS2-VASc scores were similar: 2.4±1.6 (Whites) vs. 2.2±1.6 (non-Whites).
  • Mean HAS-BLED scores were similar: 1.5±1.1 (Whites) vs. 1.3±1.0 (non-Whites).
  • The discriminative ability of both CHA2DS2-VASc and HAS-BLED scores was similar between White and non-White patients (p=0.52 and p=0.33, respectively).
  • HAS-BLED performance was consistent across Vitamin K antagonist and direct oral anticoagulant users.

Conclusions:

  • Despite lower anticoagulation rates in non-White patients, the CHA2DS2-VASc and HAS-BLED scores demonstrate similar predictive accuracy across racial groups in this US cohort.
  • These findings highlight potential disparities in anticoagulation use that warrant further investigation.
  • The validated performance of these risk scores across races supports their use in guiding AF management decisions for all patients.

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