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Stroke and Bleeding Risks in Atrial Fibrillation Are Not Static but Dynamic: A Dynamic Assessment of CHA 2 DS 2 ‐VASc and HAS‐BLED Scores in the Iranian Registry of Atrial Fibrillation (IRAF)

Year: 2025

Type: article

Abstract: BACKGROUND AND OBJECTIVES: -VASc and HAS-BLED scores over time enhances stroke and bleeding risk prediction. METHODS: In this prospective longitudinal study-based on data from the Iranian Atrial Fibrillation Registry (IRAF)-patients with available CHA₂DS₂-VASc and HAS-BLED scores at baseline, first follow-up (after 6 months), and second follow-up (after 12 months) were included. Univariable and multivariable logistic regression analyses were performed to evaluate the association of CHA₂DS₂-VASc and HAS-BLED scores (i.e., scores at baseline, first follow-up, and their difference defined as delta) with stroke and bleeding risk, respectively. RESULTS: A total of 529 patients (mean age 61.2 ± 14.3 years; 59.7% male) were included. CHA₂DS₂-VASc and HAS-BLED scores increased significantly after 6 and 12 months from recruitment. delta CHA₂DS₂-VASc score (AUC 0.69; 95% CI: 0.54-0.84) and First follow-up CHA₂DS₂-VASc score (AUC 0.70; 95% CI: 0.51-0.88) achieved higher AUCs compared to baseline CHA₂DS₂-VASc score (AUC 0.63; 95% CI: 0.44-0.82). delta HAS-BLED score had the highest AUC (AUC 0.73; 95% CI: 0.55-0.91) compared to baseline (AUC 0.58; 95% CI: 0.43-0.74) and first follow-up HAS-BLED (AUC 0.60; 95% CI: 0.44-0.80) scores. CONCLUSIONS: Regular reassessment of CHA₂DS₂-VASc and HAS-BLED scores is essential in AF patients, as stroke and bleeding risks change over time, emphasizing the need for dynamic risk stratification.

Source: Journal of Cardiovascular Electrophysiology

DOI: 10.1111/jce.70190

Authors: Amir Askarinejad, Tommaso Bucci, Enrico Tartaglia, Michele Rossi, Gregory Y. H. Lip, Majid Haghjoo