P4574Predicting postoperative atrial fibrillation after cardiac surgery: validation and comparison of CHA2DS2-VASc, POAF and HATCH risk scoring systems

Abstract

Risk predictionPurpose: The aim of the study was to demonstrate a possible interaction between COPD and CHA2DS2-VASc in predicting incident AF in a large cohort of Caucasian outpatients, participating to Catanzaro Atrial Fibrillation Project. Methods: We conducted an observational prospective cohort study that included 4322 Caucasian outpatients (2270 males and 2052 females) with a mean followup of 59.4+22.7months. All patients were referred to the University Hospital of Catanzaro for clinical evaluation and treatment of one or more of their CV risk factors. All patients underwent physical examination, standard 12-lead electrocardiogram and routine laboratory tests every 6 months, to detect AF appearance. Results: The prevalence of COPD was significantly higher in patients with CHA2DS2-VASc>2 versus CHA2DS2-VASc<2category (13.3% vs 10.5%, P=0.009). During the follow-up, 589 cases of AF were documented (3.8 events/100 patients-year), with a significantly higher incidence in patients with CHA2DS2-VASc>2 versus CHA2DS2-VASc<2 patients (13.0 vs 3.1 events/100 patients-year, P<0.0001). Patients with COPD showed a significantly higher incidence of AF versus patients without COPD (17.4 vs 8.4 events/100 patients-year, P<0.0001). In Cox regression models both CHA2DS2-VASc score (HR=4.70, 95% CI=3.63-6.08) and COPD (HR=2.04, 95% CI=1.69-2.48) significantly predicted the incidence rate of AF, and this was also confirmed when the two variables were simultaneously introduced into the same Cox model (CHA2DS2-VASc score: HR=4.59, 95% CI=3.55-5.94; COPD: HR=1.92, 95% CI=1.58-2.33). A significant competitive interaction between CHA2DS2-VASc score and COPD was found in a Cox model in patients with CHA2DS2-VASc<2 (HR=8.45, 95% CI=5.20-13.74) than in those with CHA2DS2-VASc>2. Conclusion: COPD is an independent ad strong predictor of incident AF. The presence of COPD increases the HR for incident AF about five times in patients with CHA2DS2VASc score <2, while the coexistence of a CHA2DS2Vasc score >2 minimizes the prognostic significance of COPD. This finding has a hard clinical impact since it may allow to reclassify patients considered at low risk for AF on the basis of CHA2DS2-VASc score. Further investigations are needed to confirm this finding. Background: Stroke, a major complication of atrial fibrillation (AF), is largely preventable by timely intervention with anticoagulant therapy. However, AF is silent in some patients and may escape detection until complications have occurred. Objective: In this meta-analysis we systemically evaluated the evidences regarding the association of subclinical events of rapid atrial rate episodes (AHRE) detected by implanted devices, with risk of stroke. Methods: Pubmed, Medline, EMBASE and other databases were searched up to September 2015 and reference lists of selected articles for trials that reported relation between subclinical AF and stroke, providing the hazard ratio (HR) obtained in multiple Cox regression analyses, and adjusted for all confounding variables. Most studies defined A...

Does renal dysfunction improve the predictive value of HATCH score for postoperative atrial fibrillation?

“…On this background, the increased perioperative adrenergic stress and volume overload significantly increase the risk of POAF occurrence. HATCH score proved to be a significant independent predictor of POAF in this study, which is similar with the results of the study of Burgos et al 17 . ROC curve analysis shows, however, a moderate sensitivity and specificity for this scoring model.…”