背景:CHA2DS2-VASc评分用于评估房颤(AF)/房扑(AFL)患者的血栓栓塞风险,然而,在不考虑AF/AFL存在的情况下,将其用于预测冠状动脉旁路移植术(CABG)患者出院后的结局和再入院的研究不足.我们试图评估其在预测结果方面的效用,住院时间(LOS),以及这些患者的医疗相关费用(HAC)。
方法:从2010年至2017年,国家再入院数据库(NRD)使用国际疾病分类查询了有/无AF/AFL的CABG患者,第九版和第十版(ICD-9-和-10)。使用Cox-Hazard分析的多元回归分析和多变量分析用于评估直到90天出院再入院的结果。LOS,和HAC对CHA2DS2-VASc评分(截止分数:6)从数据库中提取。
结果:在420,458例接受CABG的患者中,出院后90天内有76,859人(18.3%)再次入院。随着CHA2DS2-VASc评分的增加,90天全因再入院的统计学显着增加[无AF/AFL与AF/AFL:评分-0(2.4%vs1.4%),得分为6(3.1%对4.5%,p值<0.0001]。在TIA/中风和心力衰竭的重新入院中也看到了类似的趋势。随着CHA2DS2-VASc评分的增加,所有事件的生存率均较低(评分-0=100%;评分-6=73%,p值<0.0001)。更大的LOS和HAC与更高的CHA2DS2-VASc评分增加相关(标准化β[β];无AF/AFLvsAF/AFL:LOS=评分-1:0.08vs0.06,评分-6:0.12vs0.13。HAC=评分-1:0.02对0.009,评分-6:0.02对0.01,p值<0.001)。
结论:CHA2DS2-VASc评分是一种易于使用的工具,可预测较差的结局,更高的再入院率,较长的LOS,更高的HAC,不仅仅是接受CABG的AF/AFL患者,但在那些没有AF/AFL。
BACKGROUND: CHA2DS2-VASc score is used to assess thromboembolic risk in patients with atrial fibrillation (AF)/atrial flutter (AFL), however its utilization to predict outcomes and readmission at following discharge in patients undergoing coronary artery bypass grafting (CABG) regardless of AF/AFL presence is understudied. We sought to assess its utility in predicting outcomes, length of hospital stay (LOS), and healthcare-associated costs (HAC) in these patients.
METHODS: The National Readmission Database (NRD) was queried from 2010 to 2017 for patients with/without AF/AFL undergoing CABG using the International Classification of Diseases, Ninth and Tenth editions (ICD-9-&-10). Multiple regression analysis and multivariate analysis using Cox-Hazard analysis were used to evaluate outcomes up to 90-day readmission from discharge, LOS, and HAC against CHA2DS2-VASc score (cut-off-score:6) were abstracted from the database.
RESULTS: Of the 420,458 patients that underwent CABG, 76,859 (18.3 %) were re-admitted to hospital within 90-days from discharge. Statistically significant increase in 90-day all-cause readmissions were demonstrated with increasing CHA2DS2-VASc score [No AF/AFL vs AF/AFL: score-0 (2.4 % vs1.4 %), score-6 (3.1 % vs 4.5 %, p-value<0.0001]. Similar trends were seen in re-admissions for TIA/Stroke and heart failure. The survival rate for all events were lower with incremental increase in CHA2DS2-VASc score (score-0 = 100 %; score-6 = 73 %, p-value<0.0001). Greater LOS and HAC was associated with increasing higher CHA2DS2-VASc score (standardized-beta[β]; no AF/AFL vs AF/AFL: LOS = score-1: 0.08 vs 0.06, score-6: 0.12 vs 0.13. HAC = score-1: 0.02 vs 0.009, score-6: 0.02 vs 0.01, p-value <0.001).
CONCLUSIONS: CHA2DS2-VASc score is an easy-to-use tool that predicts poorer outcomes, higher readmission, longer LOS, higher HAC, not just in patients with AF/AFL undergoing CABG, but also in those without AF/AFL.