j o u r n a l o f s u r g i c a l r e s e a r c h x x x ( 2 0 1 4 ) 1 e6
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
CHADS2 score predicts atrial fibrillation following cardiac surgery Sohail Sareh, MS,a William Toppen, BA,a Laith Mukdad, BA,a Nancy Satou, RN,a Richard Shemin, MD,a Eric Buch, MD,b and Peyman Benharash, MDa,* a
Division of Cardiothoracic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California b Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
article info
abstract
Article history:
Background: Atrial fibrillation (AF) following cardiac surgery portends higher morbidity and
Received 4 January 2014
increased health expenditure. Although many anatomic and patient risk factors have been
Received in revised form
identified, a simple clinical scoring system to identify high-risk patients is lacking. The
2 February 2014
CHADS2 score is widely used to predict the risk of stroke in patients with AF. We assessed
Accepted 11 February 2014
the utility of this scoring algorithm in predicting the development of de novo postoperative
Available online xxx
atrial fibrillation (POAF) in cardiac surgery patients. Material and methods: A total of 2120 patients from 2008 to 2013 were identified for inclusion
Keywords:
in our analysis. CHADS2 scores were calculated, and patients grouped into low- (0), inter-
CHADS2 score
mediate- (1) and high-risk (2) categories. A multivariate regression model was developed
Cardiac surgery
to account for known risk factors of AF.
Atrial fibrillation
Results: Of the 2120 patients, 344 (16.2%) patients developed de novo POAF during their primary
Risk assessment
hospitalization. Mean CHADS2 scores for POAF patients and no POAF patients were 2.1 1.2
Postoperative complications
and 1.7 1.3 (P < 0.0001), respectively. CHADS2 score was a significant predictor of AF on multivariate regression analysis (adjusted odds ratio, 1.26; 95% confidence interval, 1.14e1.40). As CHADS2 score increased from 0 to 6, the probability of POAF increased from 11.1% to 32.7% (P < 0.0001). Compared with the low-risk group, the intermediate-risk and high-risk groups had a 1.73- and 2.58-fold increase in odds of developing POAF, respectively (P < 0.02 and P < 0.0001). Conclusions: CHADS2 score is a powerful and convenient predictor of developing POAF. We recommend its utilization in identifying high-risk patients that may benefit from pharmacologic prophylaxis. ª 2014 Elsevier Inc. All rights reserved.
1.
Introduction
With over 350,000 annual hospitalizations attributed to atrial fibrillation (AF), it is estimated to account for $6e$26 billion of health care spending in the United States annually [1,2]. Risk
factors for the development of AF include advanced age, diabetes, hypertension, valvular heart disease, heart failure, obesity, smoking, and chronic renal disease among others [3e5]. AF is also a common complication after cardiac operations, with its incidence ranging between 10% and 60% [6e9]. Although the
* Corresponding author. UCLA Division of Cardiac Surgery, 10833 Le Conte Avenue, 62-249 Center for Health Sciences, Los Angeles, CA 90095. Tel.: þ1 310 206 6717; fax: þ1 310 206 5901. E-mail address: [email protected] (P. Benharash). 0022-4804/$ e see front matter ª 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2014.02.007
2
j o u r n a l o f s u r g i c a l r e s e a r c h x x x ( 2 0 1 4 ) 1 e6
Table 1 e Baseline clinical and operative characteristics. Characteristic CHADS2 characteristics Heart failure or EF 40, % Hypertension, % Age, y (mean SD) Diabetes mellitus, % Cerebrovascular disease, % Risk factors Female, % Vascular disease, % Smoker, % Body mass index, kg/m2 (mean SD) Dyslipidemia, % Anemia, % Elevated creatinine, % Dialysis, % Mitral insufficiency, % Aortic insufficiency, % Peripheral vascular disease, % Preoperative meds Beta-blocker, % Statin, % Aspirin, % Anticoagulant, % Coumadin, % Operative characteristics Valve surgery, % Procedure time, min (mean SD) Cardiopulmonary bypass time, min (mean SD) Perioperative RBC transfusions, n (mean SD)
Total (n ¼ 2120)
No AF (n ¼ 1776)
AF (n ¼ 344)
P value
43.4 66.2 62.1 14.7 26.7 10.1
41.8 64.4 60.7 12.8 27.0 9.9
51.5 76.7 69.4 11.6 24.4 11.6
0.001
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
CHADS2 score predicts atrial fibrillation following cardiac surgery Sohail Sareh, MS,a William Toppen, BA,a Laith Mukdad, BA,a Nancy Satou, RN,a Richard Shemin, MD,a Eric Buch, MD,b and Peyman Benharash, MDa,* a
Division of Cardiothoracic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California b Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
article info
abstract
Article history:
Background: Atrial fibrillation (AF) following cardiac surgery portends higher morbidity and
Received 4 January 2014
increased health expenditure. Although many anatomic and patient risk factors have been
Received in revised form
identified, a simple clinical scoring system to identify high-risk patients is lacking. The
2 February 2014
CHADS2 score is widely used to predict the risk of stroke in patients with AF. We assessed
Accepted 11 February 2014
the utility of this scoring algorithm in predicting the development of de novo postoperative
Available online xxx
atrial fibrillation (POAF) in cardiac surgery patients. Material and methods: A total of 2120 patients from 2008 to 2013 were identified for inclusion
Keywords:
in our analysis. CHADS2 scores were calculated, and patients grouped into low- (0), inter-
CHADS2 score
mediate- (1) and high-risk (2) categories. A multivariate regression model was developed
Cardiac surgery
to account for known risk factors of AF.
Atrial fibrillation
Results: Of the 2120 patients, 344 (16.2%) patients developed de novo POAF during their primary
Risk assessment
hospitalization. Mean CHADS2 scores for POAF patients and no POAF patients were 2.1 1.2
Postoperative complications
and 1.7 1.3 (P < 0.0001), respectively. CHADS2 score was a significant predictor of AF on multivariate regression analysis (adjusted odds ratio, 1.26; 95% confidence interval, 1.14e1.40). As CHADS2 score increased from 0 to 6, the probability of POAF increased from 11.1% to 32.7% (P < 0.0001). Compared with the low-risk group, the intermediate-risk and high-risk groups had a 1.73- and 2.58-fold increase in odds of developing POAF, respectively (P < 0.02 and P < 0.0001). Conclusions: CHADS2 score is a powerful and convenient predictor of developing POAF. We recommend its utilization in identifying high-risk patients that may benefit from pharmacologic prophylaxis. ª 2014 Elsevier Inc. All rights reserved.
1.
Introduction
With over 350,000 annual hospitalizations attributed to atrial fibrillation (AF), it is estimated to account for $6e$26 billion of health care spending in the United States annually [1,2]. Risk
factors for the development of AF include advanced age, diabetes, hypertension, valvular heart disease, heart failure, obesity, smoking, and chronic renal disease among others [3e5]. AF is also a common complication after cardiac operations, with its incidence ranging between 10% and 60% [6e9]. Although the
* Corresponding author. UCLA Division of Cardiac Surgery, 10833 Le Conte Avenue, 62-249 Center for Health Sciences, Los Angeles, CA 90095. Tel.: þ1 310 206 6717; fax: þ1 310 206 5901. E-mail address: [email protected] (P. Benharash). 0022-4804/$ e see front matter ª 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2014.02.007
2
j o u r n a l o f s u r g i c a l r e s e a r c h x x x ( 2 0 1 4 ) 1 e6
Table 1 e Baseline clinical and operative characteristics. Characteristic CHADS2 characteristics Heart failure or EF 40, % Hypertension, % Age, y (mean SD) Diabetes mellitus, % Cerebrovascular disease, % Risk factors Female, % Vascular disease, % Smoker, % Body mass index, kg/m2 (mean SD) Dyslipidemia, % Anemia, % Elevated creatinine, % Dialysis, % Mitral insufficiency, % Aortic insufficiency, % Peripheral vascular disease, % Preoperative meds Beta-blocker, % Statin, % Aspirin, % Anticoagulant, % Coumadin, % Operative characteristics Valve surgery, % Procedure time, min (mean SD) Cardiopulmonary bypass time, min (mean SD) Perioperative RBC transfusions, n (mean SD)
Total (n ¼ 2120)
No AF (n ¼ 1776)
AF (n ¼ 344)
P value
43.4 66.2 62.1 14.7 26.7 10.1
41.8 64.4 60.7 12.8 27.0 9.9
51.5 76.7 69.4 11.6 24.4 11.6
0.001
