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

Background: CHADS(2) and CHA(2)DS(2)-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(2) and CHA(2)DS(2)-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 CHADS(2) and CHA(2)DS(2)-VASc scorewere associated with increased mortality from 0.4% for CHADS(2) of 0 to 3.2% for score of 6 and from 0.2% for CHA(2)DS(2)-VASc of 0 to 3.2% for score >= 8. LOS increased from 2.20 days for CHADS(2) 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 CHADS(2) of 0 to 26.0% for score of 6, and 90-day readmission rate increased from 15.2% to 39%. CHA(2)DS(2)-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(2) and CHA(2)DS(2)-VASc scores. Conclusion: CHADS(2) and CHA(2)DS(2)-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. (C) 2017 Elsevier B.V. All rights reserved.