Buck Benjamin, Okabe Toshimasa, Guha Avirup, Daoud Emile
Department of Internal Medicine, Division of Cardiovascular Disease, The Ohio State University, 395 West 12th Avenue, Suite 334, Columbus, OH, 43210-1267, USA.
Department of Internal Medicine, Division of Cardiovascular Disease, Section of Electrophysiology, The Ohio State University, Columbus, OH, USA.
J Interv Card Electrophysiol. 2019 Oct;56(1):55-61. doi: 10.1007/s10840-019-00593-0. Epub 2019 Jul 22.
Determine whether the CHADS-VASc score predicts rates of hospitalization associated with thromboembolic complications (TEC) in the 30, 60, and 90 days following cardioversion (CV) for atrial fibrillation (AF).
The 2014 National Readmissions Database was analyzed to identify readmissions following the index hospitalization for AF and CV. A CHADS-VASc score was calculated for each patient from diagnosis codes associated with the index admission. The primary outcome was the incidence of readmission due to TEC in the 30, 60, and 90 days after CV stratified by CHADS-VASc scores ≤ 1, 2-3, and ≥ 4; the secondary outcome was specific clinical risk factors independently associated with TEC within 30 days of CV.
A total of 109,420 weighted index admissions for AF and CV were identified in between January 1, 2014, and November 30, 2014. Of these, 16,535 (15.1%) had a CHADS-VASc score of 0-1, 39,544 (36.1%) had a score of 2-3, and 53,340 (48.8%) had a score of ≥ 4. Readmission due to TEC occurred in 48 (0.29%), 167 (0.42%), and 394 (0.74%) patients with CHADS-VASc scores ≤ 1, 2-3, and ≥ 4, respectively, in the 90-day period after CV. The only significant predictor for 30-day TEC-associated readmission after CV was age > 65 years old.
This study demonstrated the utility of CHADS-VASc score in predicting TEC-associated readmission rate following CV and the temporal relationship of TEC to CV. Patients > 65 years old without other comorbidities may benefit from 30-day OAC following successful CV irrespective of the duration of AF episodes.
确定CHADS-VASc评分能否预测心房颤动（AF）复律（CV）后30天、60天和90天内与血栓栓塞并发症（TEC）相关的住院率。
分析2014年国家再入院数据库，以确定AF和CV的首次住院后的再入院情况。根据与首次入院相关的诊断编码为每位患者计算CHADS-VASc评分。主要结局是CV后30天、60天和90天内按CHADS-VASc评分≤1、2 - 3和≥4分层的因TEC导致的再入院发生率；次要结局是CV后30天内与TEC独立相关的特定临床危险因素。
在2014年1月1日至2014年11月30日期间，共确定了109420例加权的AF和CV首次入院病例。其中，16535例（15.1%）的CHADS-VASc评分为0 - 1，39544例（36.1%）的评分为2 - 3，53340例（48.8%）的评分为≥4。CV后90天内，CHADS-VASc评分≤1、2 - 3和≥4的患者中，因TEC导致再入院的分别有48例（0.29%）、167例（0.42%）和394例（0.74%）。CV后30天与TEC相关再入院的唯一显著预测因素是年龄>65岁。
本研究证明了CHADS-VASc评分在预测CV后TEC相关再入院率以及TEC与CV的时间关系方面的作用。成功CV后，年龄>65岁且无其他合并症的患者，无论AF发作持续时间如何，可能从30天的口服抗凝药治疗中获益。
