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

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.