Sopan Lahewala1, Shilpkumar Arora2, Prashant Patel3, Varun Kumar4, Nirali Patel3, Byomesh Tripathi4, Nilay Patel5, Kamala Ramya Kallur4, Harshil Shah6, Amer Syed1, Umesh Gidwani6, Juan F Viles-Gonzalez7, Abhishek Deshmukh8. 1. RWJ Barnabas Health/Jersey City Medical Center, Jersey City, NJ, United States. 2. Mount Sinai St Luke's - Roosevelt Hospital, New York, NY, United States. Electronic address: shilpkumar.arora2@mountsinai.org. 3. University of Southern California, Los Angeles, CA, United States. 4. Mount Sinai St Luke's - Roosevelt Hospital, New York, NY, United States. 5. St. Peter's University Hospital, New Brunswick, NJ, United States. 6. Icahn School of Medicine at Mount Sinai, New York, NY, United States. 7. University of Miami Miller School of Medicine, Miami, FL, United States. 8. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States.
Abstract
BACKGROUND: CHADS2 and CHA2DS2-VASc scores are widely used for thromboembolic risk assessment in Atrial Fibrillation(AF) cohort, however further utilization to predict outcomes is understudied. METHOD: HCUP's National Readmission Data(NRD) 2013 was queried for AF admissions using ICD-9-CM code 427.31 in principal diagnosis field. Patients with mitral valve disease or repair/or replacement were excluded to estimate population with non-valvular AF only. CHADS2 and CHA2DS2-VASc were calculated for each patient. Hierarchical two-level logistic and linear models were used to evaluate study outcomes in terms of mortality, 30 or 90-day readmissions, length of stay(LOS) and cost. RESULT: Of 116,450 principal non-valvular AF admissions(50.2% female and 43.1% age≥75years) 29,179 patients were readmitted, with total 40,959 readmissions. Higher CHADS2 and CHA2DS2-VASc score were associated with increased mortality from 0.4% for CHADS2 of 0 to 3.2% for score of 6 and from 0.2% for CHA2DS2-VASc of 0 to 3.2% for score≥8. LOS increased from 2.20days for CHADS2 of 0 to 5.08days for score of 6, while cost increased from $7888 to $11,151. 30-day readmission rate increased from 8.9% for CHADS2 of 0 to 26.0% for score of 6, and 90-day readmission rate increased from 15.2% to 39%. CHA2DS2-VASc scoring similarly demonstrated a trend towards increasing readmission rate, LOS and cost for higher scores. Also, similar results were seen in hierarchical modeling with increment of CHADS2 and CHA2DS2-VASc scores. CONCLUSION: CHADS2 and CHA2DS2-VASc scores can be used as quick surrogate markers for predicting outcomes beyond thromboembolic risk. Physician familiarity with these systems makes them easy to use bedside clinical tools to improve outcomes and resource allocation.
BACKGROUND: CHADS2 and CHA2DS2-VASc scores are widely used for thromboembolic risk assessment in Atrial Fibrillation(AF) cohort, however further utilization to predict outcomes is understudied. METHOD: HCUP's National Readmission Data(NRD) 2013 was queried for AF admissions using ICD-9-CM code 427.31 in principal diagnosis field. Patients with mitral valve disease or repair/or replacement were excluded to estimate population with non-valvular AF only. CHADS2 and CHA2DS2-VASc were calculated for each patient. Hierarchical two-level logistic and linear models were used to evaluate study outcomes in terms of mortality, 30 or 90-day readmissions, length of stay(LOS) and cost. RESULT: Of 116,450 principal non-valvular AF admissions(50.2% female and 43.1% age≥75years) 29,179 patients were readmitted, with total 40,959 readmissions. Higher CHADS2 and CHA2DS2-VASc score were associated with increased mortality from 0.4% for CHADS2 of 0 to 3.2% for score of 6 and from 0.2% for CHA2DS2-VASc of 0 to 3.2% for score≥8. LOS increased from 2.20days for CHADS2 of 0 to 5.08days for score of 6, while cost increased from $7888 to $11,151. 30-day readmission rate increased from 8.9% for CHADS2 of 0 to 26.0% for score of 6, and 90-day readmission rate increased from 15.2% to 39%. CHA2DS2-VASc scoring similarly demonstrated a trend towards increasing readmission rate, LOS and cost for higher scores. Also, similar results were seen in hierarchical modeling with increment of CHADS2 and CHA2DS2-VASc scores. CONCLUSION: CHADS2 and CHA2DS2-VASc scores can be used as quick surrogate markers for predicting outcomes beyond thromboembolic risk. Physician familiarity with these systems makes them easy to use bedside clinical tools to improve outcomes and resource allocation.
Authors: Per Wändell; Axel C Carlsson; Martin J Holzmann; Johan Ärnlöv; Jan Sundquist; Kristina Sundquist Journal: Ann Med Date: 2017-11-27 Impact factor: 4.709
Authors: Karney Lahad; Elad Maor; Robert Klempfner; Chagai Grossman; Amit Druyan; Ilan Ben-Zvi Journal: J Gen Intern Med Date: 2022-05-27 Impact factor: 6.473