HAT₂CH₂ Score Predicts Systemic Thromboembolic Events in Elderly After Cardiac Electronic Device Implantation

Background: The HAT₂CH₂ score has been evaluated for predicting new onset atrial fibrillation, but never for adverse systemic thromboembolic events (STE) in elderly. We aimed to evaluate the HAT₂CH₂ score and comparing to atrial high rate episodes (AHRE) ≥24 h for predicting STE in older patients with cardiac implantable electronic devices (CIED) implantation. Methods: We retrospective enrolled 219 consecutive patients ≥ 65 years of age undergoing CIED implantation. The primary endpoint was subsequent STE. For all patients in the cohort, the CHA₂DS₂-VASc, C₂HEST, mC₂HEST, HAVOC, HAT₂CH₂ scores and AHRE ≥ 24 h were determined. AHRE was defined as > 175 bpm lasting ≥ 30 s. Multivariate Cox regression analysis with time-dependent covariates was used to determine variables associated with independent risk of STE. Results: The median patient age was 77 years, and 61.2% of the cohort was male. During follow-up (median, 35 months), 16 STE occurred (incidence rate, 2.51/100 patient-years; 95% CI, 1.65-5.48). Multiple Cox regression analysis showed that the HAT₂CH₂ score (HR, 3.405; 95% CI, 2.272-5.104; p < 0.001) was an independent predictor for STE. The optimal HAT₂CH₂ score cutoff value was 3, with the highest Youden index (AUC, 0.907; 95% CI, 0.853-0.962; p < 0.001). The STE rate increased with increasing HAT₂CH₂ score (p < 0.001). Conclusions: This study is the first to show the prognostic value of the HAT₂CH₂ score for STE occurrence in older patients with CIEDs.