New Combined Risk Score to Predict Atrial Fibrillation after Cardiac Surgery

Abstract

Background and Aims: Atrial fibrillation frequently occurs in the postoperative period of cardiac surgery, associated with an increase in morbidity and mortality. The scores POAF, CHA2DS2-VASc and HATCH demonstrated a validated ability to predict atrial fibrillation after cardiac surgery (AFCS). The objective is to develop and validate a risk score to predict AFCS from the combination of the variables with highest predictive value of POAF, CHA2DS2-VASc and HATCH models. Methods: We conducted a single-center cohort study, performing a retrospective analysis of prospectively collected data. The study included consecutive patients undergoing cardiac surgery in 2010-2016. The primary outcome was the development of new-onset AFCS. The variables of the POAF, CHA2DS2-VASc and HATCH scores were evaluated in a multivariate regression model to determine the predictive impact. Those variables that were independently associated with AFCS were included in the final model. Results: A total of 3113 patients underwent cardiac surgery, of which 21% presented AFCS. The variables included in the new score COM-AF were: age (≥75: 2 points, 65-74: 1 point), heart failure (2 points), female sex (1 point), hypertension (1 point), diabetes (1 point), previous stroke (2 points). For the prediction of AFCS, COM-AF presented an AUC of 0.78 (95% CI 0.76-0.80), the rest of the scores presented lower discrimination ability (P < 0.001): CHA2DS2-VASc AUC 0.76 (95% CI 0.74-0.78), POAF 0.71 (95% CI 0.69-0.73) and HATCH 0.70 (95% CI: 0, 67-0.72). Multivariable analysis demonstrated that COM-AF score was an independent predictor of AFCS: OR 1,91 (IC 95% 1,63-2,23). Conclusion: From the combination of variables with higher predictive value included in the POAF, CHA2DS2-VASc, and HATCH scores, a new risk model system called COM-AF was created to predict AFCS, presenting a greater predictive ability than the original ones. Being necessary future prospective validations.

Incidence, Risk Score Performance, and In-Hospital Outcomes of Postoperative Atrial Fibrillation After Cardiac Surgery

“…Numerous tools have been developed for predicting either POAF, such as the POAF and COM-AF risk scores, or complications from AF, such as the CHA 2 DS 2 -VASc, HATCH, and STS risk scores. 8 - 10 , 12 , 13 In the present study, all risk scores were observed to have relatively poor performance, except for the POAF-specific POAF risk score (AUROC = 0.65). Although accurately predicting POAF remains challenging, its effects on adverse patient outcomes are well documented.…”

“… 9 The COM-AF score estimates the risk of AF occurrence after cardiac surgery, taking into account variables such as age, sex, HF, hypertension, diabetes, and previous stroke, with scores ranging from 0 to 9. 10 The CHA 2 DS 2 -VASc score predicts the risk of stroke in patients with AF, incorporating factors such as congestive HF, hypertension, age, diabetes, previous transient ischemic attack or stroke, vascular disease, and sex, with scores ranging from 0 to 9. 12 Finally, the STS risk score, developed by the STS, predicts operative mortality and morbidity for patients undergoing cardiac surgery based on multiple preoperative factors, including demographics, medical history, and procedure type.…”

“… 7 Several established risk scores, such as the POAF, HATCH, and COM-AF scores, have been developed to help identify patients at risk for developing POAF. 8 - 10 Early identification of patients at risk for POAF allows for the timely initiation of prophylactic measures, such as the use of β-blockers, amiodarone, or other antiarrhythmic drugs, which have been shown to reduce the incidence of POAF. 7 , 11 The comparative performance of each risk score, however—in addition to general AF risk scores, such as the Society of Thoracic Surgeons (STS) score and the congestive HF, hypertension, age ≥75 years, diabetes, stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category (CHA 2 DS 2 -VASc) score—in predicting POAF is unknown.…”

Atrial Fibrillation Occurring During Acute Hospitalization: A Scientific Statement From the American Heart Association

“…Refining predictive and risk stratification models for acute AF is an area of active research. 67 Developing a framework to triage the intensity of electrocardiographic monitoring during acute hospitalization is an important area for future research.…”

Predictors of atrial fibrillation post coronary artery bypass graft surgery: new scoring system

“…While difficult to directly compare; the HATCH-PC model, which exclusively assesses patients for risk of POAF following CABG, demonstrated higher sensitivity but lower specificity compared with the COM-AF model, a recent model proposed in Burgos et al’s 2021 paper for predicting POAF in all postoperative cardiac patients. 26 …”