Dynamic assessment of CHA2DS2-VASc and HAS-BLED scores for predicting ischemic stroke and major bleeding in atrial fibrillation patients

María José Serna; José Miguel Rivera-Caravaca; Raquel López-Gálvez; Eva Soler-Espejo; Gregory Y H Lip; Francisco Marín; Vanessa Roldán

doi:10.1016/j.rec.2024.02.011

Dynamic assessment of CHA₂DS₂-VASc and HAS-BLED scores for predicting ischemic stroke and major bleeding in atrial fibrillation patients

Rev Esp Cardiol (Engl Ed). 2024 Mar 7:S1885-5857(24)00076-8. doi: 10.1016/j.rec.2024.02.011. Online ahead of print.

[Article in English, Spanish]

Authors

María José Serna¹, José Miguel Rivera-Caravaca², Raquel López-Gálvez³, Eva Soler-Espejo¹, Gregory Y H Lip⁴, Francisco Marín³, Vanessa Roldán¹

Affiliations

¹ Servicio de Hematología y Oncología Médica, Hospital General Universitario Morales Meseguer, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.
² Facultad de Enfermería, Universidad de Murcia, Murcia, Spain; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. Electronic address: josemiguel.rivera@um.es.
³ Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), El Palmar, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
⁴ Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Denmark.

PMID: 38460882
DOI: 10.1016/j.rec.2024.02.011

Abstract

Introduction and objectives: Stroke and bleeding risks in atrial fibrillation (AF) are often assessed at baseline to predict outcomes years later. We investigated whether dynamic changes in CHA₂DS₂-VASc and HAS-BLED scores over time modify risk prediction.

Methods: We included patients with AF who were stable while taking vitamin K antagonists. During a 6-year follow-up, all ischemic strokes/transient ischemic attacks (TIAs) and major bleeding events were recorded. CHA₂DS₂-VASc and HAS-BLED were recalculated every 2-years and tested for clinical outcomes at 2-year periods.

Results: We included 1361 patients (mean CHA₂DS₂-VASc and HAS-BLED 4.0±1.7 and 2.9±1.2). During the follow-up, 156 (11.5%) patients had an ischemic stroke/TIA and 269 (19.8%) had a major bleeding event. Compared with the baseline CHA₂DS₂-VASc, the CHA₂DS₂-VASc recalculated at 2 years had higher predictive ability for ischemic stroke/TIA during the period from 2 to 4 years. Integrated discrimination improvement (IDI) and net reclassification improvement (NRI) showed improvements in sensitivity and better reclassification. The CHA₂DS₂-VASc recalculated at 4 years had better predictive performance than the baseline CHA₂DS₂-VASc during the period from 4 to 6 years, with an improvement in IDI and an enhancement of the reclassification. The recalculated HAS-BLED at 2-years had higher predictive ability than the baseline score for major bleeding during the period from 2 to 4 years, with significant improvements in sensitivity and reclassification. A slight enhancement in sensitivity was observed with the HAS-BLED score recalculated at 4 years compared with the baseline score.

Conclusions: In AF patients, stroke and bleeding risks are dynamic and change over time. The CHA₂DS₂-VASc and HAS-BLED scores should be regularly reassessed, particularly for accurate stroke risk prediction.

Keywords: Atrial fibrillation; CHA(2)DS(2)-VASc; Escalas de riesgo; Estratificación del riesgo; Fibrilación auricular; HAS-BLED; Hemorragia; Ictus; Risk scores; Risk stratification; Stroke. Hemorrhage.