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

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: (MeSH terms): Atrial fibrillation; CHA(2)DS(2)-VASc score; Community-acquired pneumonia.