CHA2DS2-VASc and HAS-BLED scores do not predict NVAF-related events in a population of critically ill patients

Background: Non-valvular atrial fibrillation(NVAF) is commonamong critically-ill subjects and is associated to worseoutcomes.NVAF-related morbility is associated to thromboembolicand haemorragic complications.Guidelines suggest stratifying thethrombotic risk with CHA2DS2-VASc and the haemorrhagic risk withHAS-BLED. These scores are not validated for the critically-ill, andguidelines are not able to suggest any evidence-based approach.Patients and Methods: Single-cohort, perspective study enrollingall the consecutive patients admitted to our department for a crit-ical illness and affected by NVAF. We excluded patients admittedfor trauma or surgical pathologies. Embolic outcome(TE) was de-fined as the occurrence of embolic manifestations at the admis-sion or during the hospitalization. Haemorragic outcome(MH) wasdefined as the occurrence of major haemorrhage according toISTH criteria during the hospitalization or at the 12-months follow-up. For each patient, we evaluated age, sex, admission diagnosis,comorbidities, CHA2DS2-VASc, HAS-BLED, TE and MH. Results: 519 subjects[age:75.6(±11.9);males:50.3%;comorbidi-ties:2(0-6)].38 MH(7,3%),80 TE(15,4%).HAS-BLED: median of2(0-5),CHA2-DS2-VASc:median of 3(0-6);among MH, HAS-BLED:median of 3(1-4), CHA2-DS2-VASc:median of 2(1-3);amongTE,HAS-BLED: median of 2(1-3), CHA2-DS2-VASc:median of 3(1-4);CHA2DS2-VASc had an AUC of 0.56[95%CI:0.50-0:63(p=0.06)] for TE;HAS-BLED had an AUC of 0.53 [95%CI:0.44-0:62(p=0.53)] for MH. Discussion: In this population, CHA2DS2-VASc and HAS-BLEDhad limited predictive value for TE and MH.