Predicting the Outcomes of Acute Ischemic Stroke with Rheumatic Heart Disease: The Values of CHADS2, CHA2DS2–VASc, and HAS-BLED Scores

• Published in: Journal of stroke and cerebrovascular diseases Vol. 25; no. 3; pp. 722 - 726
• Main Authors: Liu, Junfeng, MD, Wang, Deren, PhD, Tan, Ge, MD, Yuan, Ruozhen, MD, Xu, Mangmang, MD, Xiong, Yao, MD, Liu, Ming, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2016
• Subjects: Adult; Aged; Anticoagulants - therapeutic use; Cardiovascular; CHA2DS2–VASc; CHADS2; Female; Follow-Up Studies; HAS-BLED; Humans; Logistic Models; Male; Middle Aged; Neurology; Outcome Assessment (Health Care); outcomes; Predictive Value of Tests; Retrospective Studies; rheumatic heart disease; Rheumatic Heart Disease - complications; Risk Assessment; Risk Factors; Severity of Illness Index; Stroke; Stroke - complications; Stroke - diagnosis; HAS-BLED; Stroke; outcomes; rheumatic heart disease; CHADS2; CHA2DS2–VASc
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.003

Background and Objective The CHADS2 and CHA2DS2–VASc score were used to evaluate the atrial fibrillation-related risk of stroke, and HAS-BLED score was used to estimate the oral anticoagulation-bleeding risk. We investigated the relationships between these 3 scores and the outcomes of acute ischemic stroke (AIS) patients with rheumatic heart disease (RHD) at 3 months after stroke. Methods We retrospectively included patients admitted within 1 month after stroke from October 2011 to February 2014 who was also diagnosed with RHD. The patients' demographics; National Institutes of Health Stroke Scale score on admission; risk factors; prior anticoagulation; and CHADS2, CHA2DS2–VASc, and HAS-BLED scores on admission were collected, and symptomatic intracranial hemorrhage (sICH) during hospitalization was observed as well. The patients were followed up at 3 months after stroke to assess the clinical outcomes. Results Of 1425 patients with AIS, 172 patients were diagnosed with RHD. Eleven patients (6.4%) were lost to follow-up at 3 months. One hundred sixty-one patients (48 males, mean age 57.5 years) were finally analyzed in the study. The HAS-BLED score was associated with the occurrence of sICH in both univariate ( P  = .001; odds ratio [OR] 2.223, 95% confidence interval [CI] 1.40-3.54) and multivariate analysis ( P  = .031; OR 2.366, 95% CI 1.08-5.17). The CHADS2 and CHA2DS2–VASc scores were both related to the sICH (CHADS2: P  = .032; OR 1.522, 95% CI 1.04-2.23; CHA2DS2–VASc: P  = .011; OR 1.498, 95% CI 1.10-2.04, respectively), and to the poor outcomes at 3 months (CHADS2: P  = .013; OR .688, 95% CI .51-.92; CHA2DS2–VASc: P  = .014; OR .754, 95% CI .60-.94, respectively) in the univariate analysis. Conclusion The HAS-BLED score was independently associated with the occurrence of sICH in AIS patients with RHD.