RWJ Barnabas Health/Jersey City Medical Center, Jersey City, NJ, United States.
Mount Sinai St Luke's - Roosevelt Hospital, New York, NY, United States.
Int J Cardiol. 2017 Oct 15;245:162-167. doi: 10.1016/j.ijcard.2017.06.090.
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.
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.
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.
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.
CHADS 和 CHADS-VASc 评分广泛用于房颤（AF）队列的血栓栓塞风险评估，但进一步用于预测结果的研究较少。
使用国际疾病分类第 9 版临床修订版（ICD-9-CM）代码 427.31 在主要诊断字段中从 HCUP 的全国再入院数据（NRD）2013 中查询 AF 入院病例。排除有二尖瓣疾病或修复/置换的患者，以估计仅患有非瓣膜性房颤的人群。为每位患者计算 CHADS 和 CHADS-VASc。使用分层两水平逻辑和线性模型，根据死亡率、30 天或 90 天再入院率、住院时间（LOS）和费用评估研究结果。
在 116450 例主要非瓣膜性 AF 入院病例（50.2%为女性，43.1%年龄≥75 岁）中，有 29179 例患者再次入院，总共有 40959 例再入院。较高的 CHADS 和 CHADS-VASc 评分与死亡率增加相关，从 CHADS 评分为 0 时的 0.4%增加到 6 时的 3.2%，从 CHADS-VASc 评分为 0 时的 0.2%增加到 8 时的 3.2%。LOS 从 CHADS 评分为 0 时的 2.20 天增加到 6 时的 5.08 天，而费用从 CHADS 评分为 0 时的 7888 美元增加到 11151 美元。30 天再入院率从 CHADS 评分为 0 时的 8.9%增加到 6 时的 26.0%，90 天再入院率从 CHADS 评分为 0 时的 15.2%增加到 39%。CHADS-VASc 评分也显示出随着评分增加，再入院率、LOS 和费用呈上升趋势。在分层建模中，随着 CHADS 和 CHADS-VASc 评分的增加，也得到了类似的结果。
CHADS 和 CHADS-VASc 评分可作为预测除血栓栓塞风险以外的预后的快速替代标志物。医生对这些系统的熟悉程度使它们成为改善预后和资源分配的简单床边临床工具。
