External Validation of the HELT-ES Score in Japanese Patients With Nonvalvular Atrial Fibrillation - A Pooled Analysis of the RAFFINE and SAKURA Registries.

BACKGROUND

The HELT-ESscore, which assigns 1 point to Hypertension, Elderly aged 75-84 years, Low body mass index <18.5 kg/m, and Type of atrial fibrillation (AF: persistent/permanent), and 2 points to Extreme Elderly aged ≥85 years and previous Stroke, has been proposed as a new risk stratification for strokes in Japanese AF patients, but has not yet undergone external validation.

METHODS AND RESULTS

We evaluated the prognostic performance of the HELT-ESscore for stroke risk stratification using 2 large-scale registries in Japanese AF patients (n=7,020). During 23,241 person-years of follow-up (mean follow-up 1,208±450 days), 287 ischemic stroke events occurred. The C-statistic using the HELT-ESscore was 0.661 (95% confidence interval [CI], 0.629-0.692), which was numerically higher than with the CHADSscore (0.644, 95% CI 0.613-0.675; P=0.15 vs. HELT-ES) or CHADS-VASc score (0.650, 95% CI, 0.619-0.680; P=0.37 vs. HELT-ES). In the SAKURA AF Registry, the C-statistic of the HELT-ESscore was consistently higher than the CHADSand CHADS-VASc scores across all 3 types of facilities comprising university hospitals, general hospitals, and clinics. However, in the RAFFINE Study, its superiority was only observed in general hospitals.

CONCLUSIONS

The HELT-ESscore demonstrated potential value for risk stratification, particularly in a super-aged society such as Japan. However, its superiority over the CHADSor CHADS-VASc scores may vary across different hospital settings.