title: Evaluating the HATCH score for predicting progression to sustained atrial fibrillation in ED patients with new atrial fibrillation.
abstract: OBJECTIVE
  Atrial fibrillation (AF) is often first detected in the emergency department (ED). Not all AF patients progress to sustained AF (ie, episodes lasting >7 days), which is associated with increased morbidity. The HATCH score stratifies patients with paroxysmal AF according to their risk for progression to sustained AF within 1 year. The HATCH score has previously never been tested in ED patients. We evaluated the accuracy of the HATCH score to predict progression to sustained AF within 1 year of initial AF diagnosis in the ED.
  
  
  METHODS
  We conducted a retrospective cohort study of 253 ED patients with new onset AF and known rhythm status for 1 year following the initial AF detection. The exposure variable was the HATCH score at initial ED evaluation. The primary outcome was rhythm status at 1 year following initial AF diagnosis. We constructed a receiver operating characteristic curve and calculated the area under the curve to estimate the HATCH score's accuracy of predicting progression to sustained AF.
  
  
  RESULTS
  Overall, 61 (24%) of 253 of patients progressed to sustained AF within 1 year of initial detection, and the HATCH score receiver operating characteristic area under the curve was 0.62 (95% confidence interval, 0.54-0.70).
  
  
  CONCLUSIONS
  Among ED patients with new onset AF, the HATCH score was a modest predictor of progression to sustained AF. Because only 2 patients had a HATCH greater than 5, this previously recommended cut-point was not useful in identifying high-risk patients in this cohort. Refinement of this decision aid is needed to improve its prognostic accuracy in the ED population.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-4700, USA. tyler.barrett@vanderbilt.edu
authors.forename: Tyler W
authors.initials: TW
authors.lastname: Barrett
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Self
authors.forename: Brian S
authors.initials: BS
authors.lastname: Wasserman
authors.forename: Candace D
authors.initials: CD
authors.lastname: McNaughton
authors.forename: Dawood
authors.initials: D
authors.lastname: Darbar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis*; D003661:Decision Support Techniques; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment