Servicio de Hematología y Oncología Médica, Hospital General Universitario Morales Meseguer, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.
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.
Rev Esp Cardiol (Engl Ed). 2024 Oct;77(10):835-842. doi: 10.1016/j.rec.2024.02.011. Epub 2024 Mar 7.
Stroke and bleeding risks in atrial fibrillation (AF) are often assessed at baseline to predict outcomes years later. We investigated whether dynamic changes in CHADS-VASc and HAS-BLED scores over time modify risk prediction.
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. CHADS-VASc and HAS-BLED were recalculated every 2-years and tested for clinical outcomes at 2-year periods.
We included 1361 patients (mean CHADS-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 CHADS-VASc, the CHADS-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 CHADS-VASc recalculated at 4 years had better predictive performance than the baseline CHADS-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.
In AF patients, stroke and bleeding risks are dynamic and change over time. The CHADS-VASc and HAS-BLED scores should be regularly reassessed, particularly for accurate stroke risk prediction.
心房颤动（AF）的中风和出血风险通常在基线时进行评估，以预测数年后的结果。我们研究了随着时间的推移，CHADS-VASc 和 HAS-BLED 评分的动态变化是否会改变风险预测。
我们纳入了正在服用维生素 K 拮抗剂且稳定的 AF 患者。在 6 年的随访期间，记录了所有缺血性中风/短暂性脑缺血发作（TIA）和主要出血事件。每 2 年重新计算 CHADS-VASc 和 HAS-BLED，并在 2 年期间测试临床结局。
我们纳入了 1361 名患者（平均 CHADS-VASc 和 HAS-BLED 分别为 4.0±1.7 和 2.9±1.2）。在随访期间，156 名（11.5%）患者发生缺血性中风/TIA，269 名（19.8%）患者发生主要出血事件。与基线 CHADS-VASc 相比，第 2 年重新计算的 CHADS-VASc 在第 2 至 4 年期间对缺血性中风/TIA 的预测能力更高。综合判别改善（IDI）和净重新分类改善（NRI）显示了敏感性的提高和更好的重新分类。第 4 年重新计算的 CHADS-VASc 在第 4 至 6 年期间的预测性能优于基线 CHADS-VASc，IDI 有所提高，重新分类得到增强。第 2 年重新计算的 HAS-BLED 在第 2 至 4 年期间对主要出血的预测能力高于基线评分，敏感性和重新分类均有显著提高。与基线评分相比，第 4 年重新计算的 HAS-BLED 敏感性略有提高。
在 AF 患者中，中风和出血风险是动态的，会随时间而变化。CHADS-VASc 和 HAS-BLED 评分应定期重新评估，特别是为了准确预测中风风险。
