Clinical Utility of the HELT-E<sub>2</sub>S<sub>2</sub> Score for Risk Stratification in Patients with Acute Decompensated Heart Failure: Insights from the CURE-HF Registry

Objective The HELT-E₂S₂ score is a novel risk assessment tool for ischemic stroke in patients with atrial fibrillation. We explored the prognostic impact of the HELT-E₂S₂ score on cardiovascular outcomes in patients with heart failure (HF), beyond its original scope. Methods We enrolled 997 patients hospitalized for acute decompensated HF (ADHF) (median age, 81 years; 44.3% female) from the Clue of Risk Stratification in the Elderly Patients with Heart Failure (CURE-HF) registry. We evaluated the relationship between the HELT-E₂S₂ score and all-cause death over a median follow-up of 2.7 years. Results The patients were categorized into four quartiles based on the HELT-E₂S₂ score: score 0 or 1 (group 1, n=234), score 2 (group 2, n=244), score 3 (group 3, n=255), and score ≥4 (group 4, n=264). Atrial fibrillation was present in 592 (59.4%) patients (paroxysmal, 15.0%; persistent, 44.3%). All-cause death was observed in 384 patients (14.7 per 100 patient-years). A Kaplan-Meier analysis showed that the higher score group was associated with an increased risk of all-cause death (log-rank p<0.001). After multivariable adjustment, the higher score groups had an elevated risk of all-cause death compared to group 1 [group 2; hazard ratio (HR): 1.56; 95% confidence interval (CI): 1.03-2.37; p=0.037, group 3; HR: 2.74; 95% CI: 1.85-4.07; p<0.001, group 4; HR: 3.32; 95% CI: 2.34-4.94; p<0.001]. Conclusion Higher HELT-E₂S₂ scores were associated with a higher risk of all-cause death in patients with ADHF.