Incidence Rate and Predictors of Intracranial Hemorrhage in Patients With Atrial Fibrillation: A Report From the Nationwide COOL-AF Registry
Issued Date
2024-12-01
Resource Type
ISSN
01609289
eISSN
19328737
Scopus ID
2-s2.0-85211495089
Journal Title
Clinical Cardiology
Volume
47
Issue
12
Rights Holder(s)
SCOPUS
Bibliographic Citation
Clinical Cardiology Vol.47 No.12 (2024)
Suggested Citation
Krittayaphong R., Ratanasumawong K., Methavigul K., Wongvipaporn C., Lip G.Y.H. Incidence Rate and Predictors of Intracranial Hemorrhage in Patients With Atrial Fibrillation: A Report From the Nationwide COOL-AF Registry. Clinical Cardiology Vol.47 No.12 (2024). doi:10.1002/clc.70040 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/102426
Title
Incidence Rate and Predictors of Intracranial Hemorrhage in Patients With Atrial Fibrillation: A Report From the Nationwide COOL-AF Registry
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Specific risk predictor scores of intracranial hemorrhage (ICH) risk in Asian subjects are lacking. We determined the incidence rate and predictors of ICH in patients with non-valvular atrial fibrillation (AF). Methods: A prospective nationwide registry of patients with AF was conducted from 27 hospitals in Thailand. The adjudicated primary outcome was the development of ICH during follow-up. Multivariable Cox proportional hazard model was performed to identify the independent predictors for ICH. A predictive model for ICH risk was developed and validated by bootstrap, calibration plot, C-statistics, and decision curve analysis using our own data. Results: We studied a total of 3405 patients (mean age 67.8 years; 58.2% male) with an average follow-up duration of 31.8 ± 8.7 months, during which ICH developed in 70 patients (2.06%). The incidence rate of ICH was 0.78 (0.61−0.98) per 100 person-years. Predictors of ICH were chosen from the theory-driven approaches in combination with the results of the univariable analysis. The predictive risk model had a c-index of 0.717 (0.702−0.732) with good calibration, internal validation, and clinical usefulness using decision curve analysis. The probability of ICH at 3 years for an individual patient derived from the prediction model was compared with the probability derived from HAS-BLED score by using the C-statistics. The ICH probability from the COOL-AF model was superior to the HAS-BLED score in the prediction of ICH. Conclusion: The incidence rate of ICH was 0.78 (0.61−0.98) per 100 person-years. Predictors of ICH were older age, male sex, nonsmoking, renal replacement therapy, and use of oral anticoagulants.