The Extended Utility of CHA2DS2VASc and HAS-BLED Scores in the Selection for Transcutaneous Left Atrial Appendage Closure
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Updated: Dec 3, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Witold Streb1, Katarzyna Mitręga1, Stanisław Morawski1
1Department of Cardiology, Congenital Heart Diseases and Electrotherapy SUM, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland.
Insights
The HAS-BLED score, not CHA2DS2-VASc, can predict prognosis after left atrial appendage closure (LAAC). Patients with higher bleeding risk benefit most from LAAC, despite worse outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Left atrial appendage closure (LAAC) is an alternative stroke prevention strategy for patients with atrial fibrillation.
- Existing randomized trials focused on average-risk populations, necessitating evaluation in broader patient groups.
Purpose of the Study:
- To assess the utility of CHA2DS2-VASc and HAS-BLED scores for patient selection and prognosis following LAAC.
- To evaluate the real-world effectiveness and safety of LAAC in a diverse patient cohort.
Main Methods:
- A cohort of 270 patients undergoing LAAC with various devices (Amplatzer Amulet, Cardiac Plug, Watchman) was analyzed.
- Prognosis was assessed based on CHA2DS2-VASc and HAS-BLED scores over a mean follow-up of 21.6 months.
Main Results:
- Observed rates of ischemic stroke (2.2%) and bleeding (0.76%) were lower than anticipated.
- Mortality was significantly associated with HAS-BLED scores (8.3% for <3, 17.9% for =3, 25.9% for >3).
- Higher HAS-BLED scores correlated with increased composite endpoints and worse prognosis.
Conclusions:
- The HAS-BLED score is a potential tool for predicting prognosis after LAAC, unlike the CHA2DS2-VASc score.
- LAAC qualification should align with anticoagulation criteria, considering stroke risk.
- Patients with the highest bleeding risk may gain the most benefit from LAAC by mitigating bleeding events.
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.
