Differences in Perceived and Predicted Bleeding Risk in Older Adults With Atrial Fibrillation: The SAGE-AF Study.
Differences in Perceived and Predicted Bleeding Risk in Older Adults With Atrial Fibrillation: The SAGE-AF Study.
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DOI：
10.1161/jaha.120.019979
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发表时间：
2021-09-07
影响因子：
5.4
通讯作者：
Saczynski JS
中科院分区：
文献类型：
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作者：
Bamgbade BA;McManus DD;Helm R;Mehawej J;Gurwitz JH;Mailhot T;Abu HO;Goldberg R;Wang Z;Tisminetzky M;Pierre-Louis IC;Saczynski JS
很少有研究评估患有房颤的口服抗凝剂使用者的出血风险感知与计算出的出血风险的比较。我们的目的是调查出血风险的低估，并描述与低估出血风险相关的特征和患者报告的结果。在 SAGE-AF（心房颤动中老年因素的系统评估）研究中，这是一项针对 65 岁以上、CHA2DS2-VASc 风险评分≥2 且接受口服抗凝治疗的心房颤动患者的前瞻性队列研究，我们将患者自我报告的出血风险与 HAS-BLED 评分预测的出血风险进行了比较。在 754 名参与者中（平均年龄 74.8 岁，48.3% 为女性），68.0% 的人低估了出血风险。亚裔或太平洋岛民、黑人、美洲原住民或阿拉斯加原住民、混血或西班牙裔（非白人）（调整后 OR [AOR]，0.45；95% CI，0.24–0.82）和女性（AOR，0.62；95% CI，0.40–0.95）参与者低估出血风险的几率显着低于各自的对照组。有出血病史（AOR，3.07；95% CI，1.73–5.44）和既往高血压病史（AOR，4.33；95% CI，2.43–7.72）、中风（AOR，5.18；95% CI，1.87–14.40）或肾脏疾病（AOR，5.05；95% CI， 2.98–8.57）低估出血风险的可能性明显更高。我们发现，超过三分之二的接受口服抗凝治疗的房颤患者低估了出血风险，有出血史和多种合并症的参与者更有可能低估其出血风险，而非白人和女性则不太可能低估其出血风险。临床医生应确保接受口服抗凝治疗的患者充分了解出血风险。
Little research has evaluated patient bleeding risk perceptions in comparison with calculated bleeding risk among oral anticoagulant users with atrial fibrillation. Our objective was to investigate underestimation of bleeding risk and to describe the characteristics and patient‐reported outcomes associated with underestimation of bleeding risk. In the SAGE‐AF (Systematic Assessment of Geriatric Elements in Atrial Fibrillation) study, a prospective cohort study of patients ≥65 years with atrial fibrillation, a CHA2DS2‐VASc risk score ≥2 and who were on oral anticoagulant therapy, we compared patients’ self‐reported bleeding risk with their predicted bleeding risk from their HAS‐BLED score. Among the 754 participants (mean age 74.8 years, 48.3% women), 68.0% underestimated their bleeding risk. Participants who were Asian or Pacific Islander, Black, Native American or Alaskan Native, Mixed Race or Hispanic (non‐White) (adjusted OR [AOR], 0.45; 95% CI, 0.24–0.82) and women (AOR, 0.62; 95% CI, 0.40–0.95) had significantly lower odds of underestimating their bleeding risk than respective comparison groups. Participants with a history of bleeding (AOR, 3.07; 95% CI, 1.73–5.44) and prior hypertension (AOR, 4.33; 95% CI, 2.43–7.72), stroke (AOR, 5.18; 95% CI, 1.87–14.40), or renal disease (AOR, 5.05; 95% CI, 2.98–8.57) had significantly higher odds of underestimating their bleeding risk. We found that more than two‐thirds of patients with atrial fibrillation on oral anticoagulant therapy underestimated their bleeding risk and that participants with a history of bleeding and several comorbid conditions were more likely to underestimate their bleeding risk whereas non‐Whites and women were less likely to underestimate their bleeding risk. Clinicians should ensure that patients prescribed oral anticoagulant therapy have a thorough understanding of bleeding risk.