External Validation of the HELT-E₂S₂ Score in Japanese Patients With Nonvalvular Atrial Fibrillation　― A Pooled Analysis of the RAFFINE and SAKURA Registries ―

Abstract

Background: The HELT-E₂S₂score, which assigns 1 point to Hypertension, Elderly aged 75–84 years, Low body mass index <18.5 kg/m², and Type of atrial fibrillation (AF: persistent/permanent), and 2 points to Extreme Elderly aged ≥85 years and previous Stroke, has been proposed as a new risk stratification for strokes in Japanese AF patients, but has not yet undergone external validation.

Methods and Results: We evaluated the prognostic performance of the HELT-E₂S₂score for stroke risk stratification using 2 large-scale registries in Japanese AF patients (n=7,020). During 23,241 person-years of follow-up (mean follow-up 1,208±450 days), 287 ischemic stroke events occurred. The C-statistic using the HELT-E₂S₂score was 0.661 (95% confidence interval [CI], 0.629–0.692), which was numerically higher than with the CHADS₂score (0.644, 95% CI 0.613–0.675; P=0.15 vs. HELT-E₂S₂) or CHA₂DS₂-VASc score (0.650, 95% CI, 0.619–0.680; P=0.37 vs. HELT-E₂S₂). In the SAKURA AF Registry, the C-statistic of the HELT-E₂S₂score was consistently higher than the CHADS₂and CHA₂DS₂-VASc scores across all 3 types of facilities comprising university hospitals, general hospitals, and clinics. However, in the RAFFINE Study, its superiority was only observed in general hospitals.

Conclusions: The HELT-E₂S₂score demonstrated potential value for risk stratification, particularly in a super-aged society such as Japan. However, its superiority over the CHADS₂or CHA₂DS₂-VASc scores may vary across different hospital settings.