Benjamin Buck1, Toshimasa Okabe2, Avirup Guha3, Emile Daoud2. 1. Department of Internal Medicine, Division of Cardiovascular Disease, The Ohio State University, 395 West 12th Avenue, Suite 334, Columbus, OH, 43210-1267, USA. Benjamin.Buck@osumc.edu. 2. Department of Internal Medicine, Division of Cardiovascular Disease, Section of Electrophysiology, The Ohio State University, Columbus, OH, USA. 3. Department of Internal Medicine, Division of Cardiovascular Disease, The Ohio State University, 395 West 12th Avenue, Suite 334, Columbus, OH, 43210-1267, USA.
Abstract
PURPOSE: Determine whether the CHA2DS2-VASc score predicts rates of hospitalization associated with thromboembolic complications (TEC) in the 30, 60, and 90 days following cardioversion (CV) for atrial fibrillation (AF). METHODS: The 2014 National Readmissions Database was analyzed to identify readmissions following the index hospitalization for AF and CV. A CHA2DS2-VASc score was calculated for each patient from diagnosis codes associated with the index admission. The primary outcome was the incidence of readmission due to TEC in the 30, 60, and 90 days after CV stratified by CHA2DS2-VASc scores ≤ 1, 2-3, and ≥ 4; the secondary outcome was specific clinical risk factors independently associated with TEC within 30 days of CV. RESULTS: A total of 109,420 weighted index admissions for AF and CV were identified in between January 1, 2014, and November 30, 2014. Of these, 16,535 (15.1%) had a CHA2DS2-VASc score of 0-1, 39,544 (36.1%) had a score of 2-3, and 53,340 (48.8%) had a score of ≥ 4. Readmission due to TEC occurred in 48 (0.29%), 167 (0.42%), and 394 (0.74%) patients with CHA2DS2-VASc scores ≤ 1, 2-3, and ≥ 4, respectively, in the 90-day period after CV. The only significant predictor for 30-day TEC-associated readmission after CV was age > 65 years old. CONCLUSIONS: This study demonstrated the utility of CHA2DS2-VASc score in predicting TEC-associated readmission rate following CV and the temporal relationship of TEC to CV. Patients > 65 years old without other comorbidities may benefit from 30-day OAC following successful CV irrespective of the duration of AF episodes.
PURPOSE: Determine whether the CHA2DS2-VASc score predicts rates of hospitalization associated with thromboembolic complications (TEC) in the 30, 60, and 90 days following cardioversion (CV) for atrial fibrillation (AF). METHODS: The 2014 National Readmissions Database was analyzed to identify readmissions following the index hospitalization for AF and CV. A CHA2DS2-VASc score was calculated for each patient from diagnosis codes associated with the index admission. The primary outcome was the incidence of readmission due to TEC in the 30, 60, and 90 days after CV stratified by CHA2DS2-VASc scores ≤ 1, 2-3, and ≥ 4; the secondary outcome was specific clinical risk factors independently associated with TEC within 30 days of CV. RESULTS: A total of 109,420 weighted index admissions for AF and CV were identified in between January 1, 2014, and November 30, 2014. Of these, 16,535 (15.1%) had a CHA2DS2-VASc score of 0-1, 39,544 (36.1%) had a score of 2-3, and 53,340 (48.8%) had a score of ≥ 4. Readmission due to TEC occurred in 48 (0.29%), 167 (0.42%), and 394 (0.74%) patients with CHA2DS2-VASc scores ≤ 1, 2-3, and ≥ 4, respectively, in the 90-day period after CV. The only significant predictor for 30-day TEC-associated readmission after CV was age > 65 years old. CONCLUSIONS: This study demonstrated the utility of CHA2DS2-VASc score in predicting TEC-associated readmission rate following CV and the temporal relationship of TEC to CV. Patients > 65 years old without other comorbidities may benefit from 30-day OAC following successful CV irrespective of the duration of AF episodes.