The HAT₂CH₂ score predicts neurologic events in patients with cardiac implantable electronic devices without atrial fibrillation

Background: The HAT₂CH₂ score has been evaluated for predicting new-onset atrial fibrillation (AF) in several clinical conditions but never for adverse neurologic events. We aimed to evaluate the HAT₂CH₂ score for predicting neurologic events in patients with cardiac implantable electronic devices (CIED). Methods and results: We retrospectively reviewed 470 consecutive patients who had CIED without a history of AF. The primary endpoint was a neurologic event, i.e. ischemic stroke or transient ischemic attack. Multivariate Cox regression analysis with time-dependent covariates was used to determine variables associated with independent factors of neurologic events. Patients’ median age was 76 years, and 58.7% were male. During follow-up (median 29 months), 21 neurologic events occurred (incidence rate 1.85/100 patient-years, 95% CI 1.03-3.83). Multivariable Cox regression analysis revealed that the HAT₂CH₂ score (HR 3.397, 95% CI 2.357-4.895, p < 0.001) was an independent predictor for neurologic events. Optimal HAT₂CH₂ score cut-off value was 3, with highest Youden index (AUC, 0.923; 95% CI, 0.886–0.959; p < 0.001). The rate of neurologic events increased significantly with increasing HAT₂CH₂ score (p < 0.001). Conclusions: The HAT₂CH₂ score can predict the occurrence of neurologic events in patients with CIED with no history of AF. Further study of the utility of the HAT₂CH₂ score for the assessment of neurologic event risk and the selection of anti-thrombotic therapy in patients with CIED without prior AF is warranted.