Atrial fibrillation: Utility of CHADS2 and CHA2DS2-VASc scores as predictors of readmission, mortality and resource utilization

Sopan Lahewala, Shilpkumar Arora, Prashant Patel, Varun Kumar, Nirali Patel, Byomesh Tripathi, Nilay Patel, Kamala Ramya Kallur, Harshil Shah, Amer Syed, Umesh Gidwani, Juan Viles Gonzalez, Abhishek Deshmukh

Research output: Contribution to journalArticle

4 Citations (Scopus)

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 ≥ 75 years) 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 2.20 days for CHADS2 of 0 to 5.08 days 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.

Original languageEnglish (US)
Pages (from-to)162-167
Number of pages6
JournalInternational Journal of Cardiology
Volume245
DOIs
StatePublished - Oct 15 2017

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Atrial Fibrillation
Length of Stay
Mortality
Costs and Cost Analysis
Resource Allocation
International Classification of Diseases
Mitral Valve
Linear Models
Biomarkers
Logistic Models
Outcome Assessment (Health Care)
Physicians
Population

Keywords

  • Atrial fibrillation
  • CHADS-VASc
  • CHADS
  • Mortality
  • Readmission

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Atrial fibrillation : Utility of CHADS2 and CHA2DS2-VASc scores as predictors of readmission, mortality and resource utilization. / 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; Deshmukh, Abhishek.

In: International Journal of Cardiology, Vol. 245, 15.10.2017, p. 162-167.

Research output: Contribution to journalArticle

Lahewala, S, Arora, S, Patel, P, Kumar, V, Patel, N, Tripathi, B, Patel, N, Kallur, KR, Shah, H, Syed, A, Gidwani, U, Viles Gonzalez, J & Deshmukh, A 2017, 'Atrial fibrillation: Utility of CHADS2 and CHA2DS2-VASc scores as predictors of readmission, mortality and resource utilization', International Journal of Cardiology, vol. 245, pp. 162-167. https://doi.org/10.1016/j.ijcard.2017.06.090
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 ; Deshmukh, Abhishek. / Atrial fibrillation : Utility of CHADS2 and CHA2DS2-VASc scores as predictors of readmission, mortality and resource utilization. In: International Journal of Cardiology. 2017 ; Vol. 245. pp. 162-167.
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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 ≥ 75 years) 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 2.20 days for CHADS2 of 0 to 5.08 days 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.",
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T2 - Utility of CHADS2 and CHA2DS2-VASc scores as predictors of readmission, mortality and resource utilization

AU - Lahewala, Sopan

AU - Arora, Shilpkumar

AU - Patel, Prashant

AU - Kumar, Varun

AU - Patel, Nirali

AU - Tripathi, Byomesh

AU - Patel, Nilay

AU - Kallur, Kamala Ramya

AU - Shah, Harshil

AU - Syed, Amer

AU - Gidwani, Umesh

AU - Viles Gonzalez, Juan

AU - Deshmukh, Abhishek

PY - 2017/10/15

Y1 - 2017/10/15

N2 - 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 ≥ 75 years) 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 2.20 days for CHADS2 of 0 to 5.08 days 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.

AB - 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 ≥ 75 years) 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 2.20 days for CHADS2 of 0 to 5.08 days 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.

KW - Atrial fibrillation

KW - CHADS-VASc

KW - CHADS

KW - Mortality

KW - Readmission

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