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Published on: February 26, 2013
CHADS2 score predicts atrial fibrillation following cardiac surgery
Sohail Sareh1, William Toppen1, Laith Mukdad1
1Division of Cardiothoracic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Insights
The CHADS2 score effectively predicts new-onset atrial fibrillation (AF) after heart surgery. This simple tool can identify patients at higher risk for postoperative AF (POAF), guiding preventative treatment strategies.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Postoperative atrial fibrillation (POAF) increases morbidity and healthcare costs after cardiac surgery.
- Existing risk factors for POAF are numerous, but a simple predictive scoring system is needed.
- The CHADS2 score is established for predicting stroke risk in patients with atrial fibrillation.
Purpose of the Study:
- To evaluate the CHADS2 score's effectiveness in predicting de novo postoperative atrial fibrillation (POAF) in cardiac surgery patients.
- To determine if the CHADS2 score can identify patients at high risk for developing POAF.
Main Methods:
- Analysis of 2120 cardiac surgery patients from 2008-2013.
- Calculation of CHADS2 scores and categorization into low (0), intermediate (1), and high (≥2) risk groups.
- Multivariate regression analysis to identify predictors of POAF, controlling for known risk factors.
Main Results:
- 16.2% of patients (344/2120) developed de novo POAF.
- Mean CHADS2 scores were significantly higher in POAF patients (2.1 ± 1.2) versus non-POAF patients (1.7 ± 1.3).
- Increased CHADS2 scores correlated with a higher probability of POAF, with high-risk patients showing a 2.58-fold increased odds.
Conclusions:
- The CHADS2 score is a potent and practical predictor of developing POAF.
- Utilizing the CHADS2 score can aid in identifying patients who may benefit from prophylactic pharmacologic treatment.
- This scoring system offers a valuable tool for risk stratification in the context of cardiac surgery.
Background:
Atrial fibrillation (AF) following cardiac surgery portends higher morbidity and increased health expenditure. Although many anatomic and patient risk factors have been identified, a simple clinical scoring system to identify high-risk patients is lacking. The CHADS2 score is widely used to predict the risk of stroke in patients with AF. We assessed the utility of this scoring algorithm in predicting the development of de novo postoperative atrial fibrillation (POAF) in cardiac surgery patients.
Material And Methods:
A total of 2120 patients from 2008 to 2013 were identified for inclusion in our analysis. CHADS2 scores were calculated, and patients grouped into low- (0), intermediate- (1) and high-risk (≥2) categories. A multivariate regression model was developed to account for known risk factors of AF.
Results:
Of the 2120 patients, 344 (16.2%) patients developed de novo POAF during their primary hospitalization. Mean CHADS2 scores for POAF patients and no POAF patients were 2.1 ± 1.2 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, 1.14-1.40). 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.
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