title: Usefulness of a low CHADS2 or CHA2DS2-VASc score to predict normal diagnostic testing in emergency department patients with an acute exacerbation of previously diagnosed atrial fibrillation.
abstract: International guidelines do not specify what testing should be performed during emergency department (ED) evaluations for patients presenting with an exacerbation of previously diagnosed atrial fibrillation (AF). We hypothesized that low CHADS2 and CHA2DS2-VASc scores predict normal routine diagnostic testing in these patients. We conducted an analysis within a prospective observational cohort study at a university-affiliated hospital. We included patients with previously diagnosed AF and who presented to the ED primarily for an AF-related complaint. Logistic regression was used to analyze the association between CHADS2 and CHA2DS2-VASc scores and abnormal results for blood counts, electrolytes, cardiac markers, thyroid function, and chest x-rays. We included 216 patients in this analysis. The odds ratios (95% confidence interval) for each point increase in CHADS2 for abnormal blood counts, electrolytes, troponin I, brain natriuretic peptide, thyroid function, and chest x-ray were 1.28 (0.99 to 1.65), 1.48 (1.19 to 1.84), 1.42 (1.10 to 1.82), 1.66 (1.15 to 2.41), 0.95 (0.70 to 1.29), and 1.17 (0.94 to 1.44), respectively. The corresponding odds ratios (95% confidence interval) for each point increase in CHA2DS2-VASc were 1.17 (0.96 to 1.42), 1.27 (1.09 to 1.49), 1.30 (1.07 to 1.57), 1.57 (1.18 to 2.10), 0.98 (0.79 to 1.22), and 1.14 (0.97 to 1.33), respectively. Among ED patients with established AF who underwent evaluation for acutely symptomatic AF, nearly 3/4 of routine diagnostic tests return to normal. In conclusion, patients with CHADS2 or CHA2DS2-VASc score of 0 have the lowest likelihood of abnormal studies and may represent an easily identifiable group of patients who need fewer ED tests.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: tybarrett@gmail.com.
authors.forename: Tyler W
authors.initials: TW
authors.lastname: Barrett
authors.affiliation: Department of Medicine, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Abraham
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Self
mesh_terms: D000208:Acute Disease; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D003935:Diagnostic Techniques, Cardiovascular / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D015996:Survival Rate; D013923:Thromboembolism / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology