Key result
Higher HAS-BLED scores link to ~3-fold higher post-LAAC mortality.
Why the study?
Randomized studies of LAAC included patients with average stroke and bleeding risk, but the extended utility of CHA2DS2VASc and HAS-BLED scores for qualification and prognosis after LAAC remains to be assessed.
Do CHA2DS2VASc and HAS-BLED scores predict prognosis in atrial fibrillation patients after left atrial appendage closure?
Cohort (n=270)
Do CHA2DS2VASc and HAS-BLED scores predict prognosis in atrial fibrillation patients after left atrial appendage closure?
The HAS-BLED score, but not the CHA2DS2VASc score, is a useful tool for predicting mortality and prognosis in patients undergoing left atrial appendage closure.
May support LAAC in high CHA2DS2VASc AF; leaves open randomized confirmation beyond average-risk trials.
Background and purpose: Left atrial appendage closure (LAAC) is an option for stroke prevention in atrial fibrillation patients. Randomized studies have demonstrated the effectiveness and safety of LAAC but included patients with an average risk of stroke and bleeding complications. The current study aimed to assess the extended utility of CHA2DS2VASc (congestive heart failure; hypertension; age ≥75 years [doubled]; type 2 diabetes; previous stroke, transient ischemic attack, or thromboembolism [doubled]; vascular disease; age 65 to 75 years; and sex category) and HAS-BLED (hypertension; abnormal renal/liver function; stroke; bleeding history or predisposition; labile INR, elderly, drugs/alcohol concomitantly) scores for qualification and prognosis after LAAC. Methods: The study population comprised 270 patients aged 72.8 ± 8.78 years. The occluders used were the Amplatzer Amulet (N = 205), Amplatzer Cardiac Plug (N = 53), and Watchman device (N = 12). The prognosis after LAAC was analyzed for different cohorts of patients distinguished based on different CHA2DS2VASc and HAS-BLED scores. The mean duration of follow-up was 21.6 ± 10.3 months. Results: The observed rates of ischemic stroke and bleeding were much lower than that expected (2.2% vs. 5.6%, and 0.76% vs. 6.05%, respectively). The mortality rate did not differ concerning the CHA2DS2CVASc score. It was significantly lower (8.3%) for HAS-BLED < 3, and it raised to 17.9% for HAS-BLED = 3 and to 25.9% for HAS-BLED > 3. Significant differences (p = 0.003) occurred for Kaplan–Meier curves for extreme HAS-BLED subgroups. A composite endpoint was most often found in high/very high risk of bleeding patients. Conclusions: HAS-BLED, but not CHA2DS2CVASc score, may be a useful tool to predict the prognosis of patients after LAAC. Qualification for LAAC based on the risk of stroke should not differ from qualification for anticoagulation. Despite the worse prognosis of patients with the highest bleeding risk, this group is likely to experience the greatest benefit from reducing the bleeding risk from LAAC.
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Streb et al. (2020) conducted a cohort in Atrial fibrillation (n=270). HAS-BLED and CHA2DS2VASc scores vs. Lower score strata / expected rates was evaluated on Mortality across HAS-BLED score strata (p=0.003). Higher HAS-BLED scores significantly predicted increased mortality after left atrial appendage closure, rising from 8.3% for HAS-BLED < 3 to 25.9% for HAS-BLED > 3 (P=0.003).
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