Atrial fibrillation: Utility of CHADS 2 and CHA 2 DS 2 -VASc scores as predictors of readmission, mortality and resource utilization
| Autor: | Harshil Shah, Prashant Patel, Juan F. Viles-Gonzalez, Umesh Gidwani, Amer Syed, Kamala Ramya Kallur, Shilpkumar Arora, Nilay Patel, Nirali Patel, Sopan Lahewala, Abhishek Deshmukh, Varun Kumar, Byomesh Tripathi |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
education.field_of_study Hierarchical modeling business.industry Population Atrial fibrillation 030204 cardiovascular system & hematology medicine.disease Readmission rate Thromboembolic risk 03 medical and health sciences 0302 clinical medicine Internal medicine parasitic diseases Cohort medicine Cardiology 030212 general & internal medicine Principal diagnosis Cardiology and Cardiovascular Medicine education business Resource utilization |
| Zdroj: | International Journal of Cardiology. 245:162-167 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2017.06.090 |
| Popis: | Background CHADS 2 and CHA 2 DS 2 -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. CHADS 2 and CHA 2 DS 2 -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 CHADS 2 and CHA 2 DS 2 -VASc score were associated with increased mortality from 0.4% for CHADS 2 of 0 to 3.2% for score of 6 and from 0.2% for CHA 2 DS 2 -VASc of 0 to 3.2% for score≥8. LOS increased from 2.20days for CHADS 2 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 CHADS 2 of 0 to 26.0% for score of 6, and 90-day readmission rate increased from 15.2% to 39%. CHA 2 DS 2 -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 CHADS 2 and CHA 2 DS 2 -VASc scores. Conclusion CHADS 2 and CHA 2 DS 2 -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. |
| Databáze: | OpenAIRE |
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