CHA 2 DS 2 -VASc predicts readmission, outcomes and resource utilization in patients undergoing coronary artery bypass grafting: A 7-year National Readmission Database study.

Autor: Wafa SEI; Department of Cardiology, Russell's Hall Hospital, Dudley Group NHS Foundation Trust, UK., Sawatari H; Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University (JP), Japan., Ahmed R; Department of Cardiology, Royal Brompton Hospital and Harefield Hospitals, London, UK., Deshpande S; Sri Jayadeva Institute of Cardiovascular Sciences and Research, India., Khan H; Norton Heart Specialists, Norton Healthcare, Louisville, KY, USA., Providencia R; Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, UK; Institute of Health Informatics Research, Univestity College London, London, UK; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, UK., Padmanabhan D; Sri Jayadeva Institute of Cardiovascular Sciences and Research, India; Division of Cardiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA., Somers VK; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA., Ramphul K; Independent Researcher, Triolet, Mauritius., Awad W; Department of Cardiothoracic Surgery, Barts Health NHS Trust, UK., Chahal CAA; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, UK; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Centre for Inherited Cardiovascular Diseases, WellSpan Health, York, PA, USA; NIHR Barts Cardiovascular Biomedical Research Centre, Barts and the London School of Medicine and Dentistry, Queen Mary University, UK., Khanji MY; Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, UK; Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, UK; NIHR Barts Cardiovascular Biomedical Research Centre, Barts and the London School of Medicine and Dentistry, Queen Mary University, UK. Electronic address: m.khanji@qmul.ac.uk.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2024 Dec 15; Vol. 417, pp. 132529. Date of Electronic Publication: 2024 Sep 06.
DOI: 10.1016/j.ijcard.2024.132529
Abstrakt: Background: CHA2DS2-VASc score is used to assess thromboembolic risk in patients with atrial fibrillation (AF)/atrial flutter (AFL), however its utilization to predict outcomes and readmission at following discharge in patients undergoing coronary artery bypass grafting (CABG) regardless of AF/AFL presence is understudied. We sought to assess its utility in predicting outcomes, length of hospital stay (LOS), and healthcare-associated costs (HAC) in these patients.
Method: The National Readmission Database (NRD) was queried from 2010 to 2017 for patients with/without AF/AFL undergoing CABG using the International Classification of Diseases, Ninth and Tenth editions (ICD-9-&-10). Multiple regression analysis and multivariate analysis using Cox-Hazard analysis were used to evaluate outcomes up to 90-day readmission from discharge, LOS, and HAC against CHA 2 DS 2 -VASc score (cut-off-score:6) were abstracted from the database.
Results: Of the 420,458 patients that underwent CABG, 76,859 (18.3 %) were re-admitted to hospital within 90-days from discharge. Statistically significant increase in 90-day all-cause readmissions were demonstrated with increasing CHA 2 DS 2 -VASc score [No AF/AFL vs AF/AFL: score-0 (2.4 % vs1.4 %), score-6 (3.1 % vs 4.5 %, p-value<0.0001]. Similar trends were seen in re-admissions for TIA/Stroke and heart failure. The survival rate for all events were lower with incremental increase in CHA 2 DS 2 -VASc score (score-0 = 100 %; score-6 = 73 %, p-value<0.0001). Greater LOS and HAC was associated with increasing higher CHA 2 DS 2 -VASc score (standardized-beta[β]; no AF/AFL vs AF/AFL: LOS = score-1: 0.08 vs 0.06, score-6: 0.12 vs 0.13. HAC = score-1: 0.02 vs 0.009, score-6: 0.02 vs 0.01, p-value <0.001).
Conclusion: CHA 2 DS 2 -VASc score is an easy-to-use tool that predicts poorer outcomes, higher readmission, longer LOS, higher HAC, not just in patients with AF/AFL undergoing CABG, but also in those without AF/AFL.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. C. Anwar A. Chahal reports a relationship with American Heart Association that includes: funding grants. Dr. C. Anwar A. Chahal reports a relationship with National Institutes of Health that includes: funding grants. Dr. C. Anwar A. Chahal reports a relationship with Mayo Foundation for Medical Education and Research that includes: funding grants. Dr. C. Anwar A. Chahal reports a relationship with Paul and Ruby Tsai Foundation that includes: funding grants. Dr. Virend K. Somers reports a relationship with ResMed that includes: consulting or advisory. Dr. Virend K. Somers reports a relationship with Respicardia that includes: consulting or advisory. Dr. Virend K. Somers reports a relationship with Lilly and Jazz Pharmaceuticals that includes: consulting or advisory. Dr. Virend K. Somers reports a relationship with Sleep Number Scientific Advisory Board that includes: board membership. Other authors have no conflicts if interest to declare.
(Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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