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)

Background and Objectives Proper stroke and bleeding risk assessment is an essential part of clinical decision‐making in patients with atrial fibrillation (AF). This study aims to determine whether the dynamic assessment of CHA 2 DS 2 ‐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.