Atrial fibrillation: Utility of CHADS and CHADS-VASc scores as predictors of readmission, mortality and resource utilization
Document Type
Article
Abstract
BACKGROUND: CHADS and CHADS-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 and CHADS-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 and CHADS-VASc score were associated with increased mortality from 0.4% for CHADS of 0 to 3.2% for score of 6 and from 0.2% for CHADS-VASc of 0 to 3.2% for score≥8. LOS increased from 2.20days for CHADS 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 of 0 to 26.0% for score of 6, and 90-day readmission rate increased from 15.2% to 39%. CHADS-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 and CHADS-VASc scores. CONCLUSION: CHADS and CHADS-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.
Medical Subject Headings
Aged; Aged, 80 and over; Atrial Fibrillation (diagnosis, mortality, therapy); Cohort Studies; Female; Health Resources (statistics & numerical data, trends); Humans; Male; Middle Aged; Mortality (trends); Patient Readmission (trends); Predictive Value of Tests; Retrospective Studies; Risk Factors; Severity of Illness Index
Publication Date
10-15-2017
Publication Title
International journal of cardiology
E-ISSN
1874-1754
Volume
245
First Page
162
Last Page
167
PubMed ID
28874288
Digital Object Identifier (DOI)
10.1016/j.ijcard.2017.06.090
Recommended Citation
Lahewala, Sopan; Arora, Shilpkumar; Patel, Prashant; Kumar, Varun; Patel, Nirali; Tripathi, Byomesh; Patel, Nilay; Kallur, Kamala Ramya; Shah, Harshil; Syed, Amer; Gidwani, Umesh; Viles-Gonzalez, Juan F.; and Deshmukh, Abhishek, "Atrial fibrillation: Utility of CHADS and CHADS-VASc scores as predictors of readmission, mortality and resource utilization" (2017). Neurology. 2062.
https://scholar.barrowneuro.org/neurology/2062