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. 2021 Sep 7;10(17):e019979.
doi: 10.1161/JAHA.120.019979. Epub 2021 Aug 16.

Differences in Perceived and Predicted Bleeding Risk in Older Adults With Atrial Fibrillation: The SAGE-AF Study

Benita A Bamgbade  1 , David D McManus  2   3 , Robert Helm  4 , Jordy Mehawej  2 , Jerry H Gurwitz  3   5   6 , Tanya Mailhot  7   8 , Hawa O Abu  2 , Robert Goldberg  3 , Ziyue Wang  3 , Mayra Tisminetzky  3   6 , Isabelle C Pierre-Louis  9 , Jane S Saczynski  1
Affiliations

Differences in Perceived and Predicted Bleeding Risk in Older Adults With Atrial Fibrillation: The SAGE-AF Study

Benita A Bamgbade et al. J Am Heart Assoc. .

Abstract

Background 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. Methods and Results 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. Conclusions 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.

Keywords: anticoagulant; atrial fibrillation; bleeding risk perception; predicted bleeding risk.

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Conflict of interest statement

D.D.M. has received honorary, speaking/consulting fee or grants from Flexcon, Rose Consulting, Bristol‐Myers Squibb, Pfizer, Boston Biomedical Associates, Samsung, Phillips, Mobile Sense, CareEvolution, Flexcon Boehringer Ingelheim, Biotronik, Otsuka Pharmaceuticals, and Sanofi. Dr McManus also declares financial support for serving on the Steering Committee for the GUARD‐AF study (NCT04126486) and Advisory Committee for the Fitbit Heart Study. The remaining authors have no disclosures to report.

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References

    1. Wändell P, Carlsson AC, Gasevic D, Wahlström L, Sundquist J, Sundquist K. Depression or anxiety and all‐cause mortality in adults with atrial fibrillation–a cohort study in Swedish primary care. Ann Med. 2016;48:59–66. DOI: 10.3109/07853890.2015.1132842. - DOI - PMC - PubMed
    1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castellá M, Diener H‐C, Heidbuchel H, Hendriks J, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2016;50:e1–e88. DOI: 10.1016/j.rec.2016.11.033. - DOI - PubMed
    1. Amin A. Oral anticoagulation to reduce risk of stroke in patients with atrial fibrillation: current and future therapies. Clin Interv Aging. 2013;8:75. DOI: 10.2147/CIA.S37818. - DOI - PMC - PubMed
    1. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta‐analysis of randomised trials. Lancet. 2014;383:955–962. DOI: 10.1016/S0140-6736(13)62343-0. - DOI - PubMed
    1. Sarrazin MSV, Cram P, Mazur A, Ward M, Reisinger HS. Patient perspectives of dabigatran: analysis of online discussion forums. Patient. 2014;7:47–54. DOI: 10.1007/s40271-013-0027-y. - DOI - PMC - PubMed

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