The HATCH score predicts neurologic events in patients with cardiac implantable electronic devices without atrial fibrillation.

BACKGROUND

The HATCH score has been evaluated for predicting new-onset atrial fibrillation (AF) in several clinical conditions but never for adverse neurologic events. We aimed to evaluate the HATCH score for predicting neurologic events in patients with cardiac implantable electronic devices (CIED).

METHODS AND RESULTS

We retrospectively reviewed 470 consecutive patients who had CIED without a history of AF. The primary endpoint was a neurologic event, i.e. ischemic stroke or transient ischemic attack. Multivariate Cox regression analysis with time-dependent covariates was used to determine variables associated with independent factors of neurologic events. Patients' median age was 76 years, and 58.7% were male. During follow-up (median 29 months), 21 neurologic events occurred (incidence rate 1.85/100 patient-years, 95% CI 1.03-3.83). Multivariable Cox regression analysis revealed that the HATCH score (HR 3.397, 95% CI 2.357-4.895, p < 0.001) was an independent predictor for neurologic events. Optimal HATCH score cut-off value was 3, with highest Youden index (AUC, 0.923; 95% CI, 0.886-0.959; p < 0.001). The rate of neurologic events increased significantly with increasing HATCH score (p < 0.001).

CONCLUSIONS

The HATCH score can predict the occurrence of neurologic events in patients with CIED with no history of AF. Further study of the utility of the HATCH score for the assessment of neurologic event risk and the selection of anti-thrombotic therapy in patients with CIED without prior AF is warranted.