Evaluación dinámica de las escalas CHA2DS2-VASc y HAS-BLED para predecir ictus isquémico y hemorragia mayor en pacientes con fibrilación auricular

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.