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Performance of the CHA2DS2-VASc score in predicting new onset atrial fibrillation during hospitalization for community-acquired pneumonia

Published:January 25, 2019DOI:https://doi.org/10.1016/j.ejim.2019.01.012

      Highlights

      • New-onset atrial fibrillation (NOAF) is a common during hospitalization for CAP.
      • CHA2DS2-VASc score is an accurate predictor of NOAF in patients hospitalized for CAP.
      • A CHA2DS2-VASc >3 can identify patients at greater risk of NOAF.

      Abstract

      Background

      Cardiovascular events are common during hospitalization for community-acquired pneumonia (CAP), with new onset atrial fibrillation (NOAF) being the second most relevant complication. In this study, we aimed to investigate the role of CHA2DS2-VASc score in predicting NOAF during hospitalization for CAP.

      Methods

      Patients admitted for CAP were prospectively assessed using CHA2DS2-VASc. The end-point of the study was the occurrence of any objectively documented episode of NOAF during hospitalization in patients that were in sinus rhythm at hospital admission.

      Results

      Of 468 patients enrolled (median age 76 years), 48 (10.3%) experienced NOAF during hospitalization. They were older, had more comorbidities, more severe pneumonia, and higher CHA2DS2-VASc than those who remained in sinus rhythm (4.4 ± 1.6 vs 3.4 ± 1.9, respectively; p < .0001). There was a direct relationship between CHA2DS2-VASc score and risk of NOAF. At ROC curve analysis, a CHA2DS2-VASc score > 3 was the most accurate cut-off for prediction of NOAF (AUC 0.653; 95% CI 0.577–0.729; p = .001). In two different multivariable models, each CHA2DS2-VASc point increase and a score > 3 both were independently associated with NOAF (HR 1.3; 95% CI 1.09–1.55; p = .003 and 2.3; 95% CI 1.19–4.44; p = .007, respectively).

      Conclusions

      CHA2DS2-VASc score is an accurate and independent predictor of NOAF in patients with CAP, and a score > 3 features a population at high risk of developing the arrhythmia during hospitalization. This simple and effective tool should be incorporated in the evaluation of patients hospitalized for CAP, with implications ranging from arrhythmic prevention to anticoagulation management.

      Keywords

      Abbreviations:

      AF (atrial fibrillation), CAP (community-acquired pneumonia), CHA2DS2-VASc (Congestive heart failure/left ventricular dysfunction, Hypertension, Age (≥ 75 years 2 points), Diabetes, Stroke/transient ischemic attack (2 points), Vascular disease, Sex category), CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, age >65 years), CV (cardiovascular), NOAF (new onset atrial fibrillation)
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