Evaluating the HATCH score for predicting progression to sustained atrial fibrillation in ED patients with new atrial fibrillation.

Barrett TW, Self WH, Wasserman BS, McNaughton CD, Darbar D
Am J Emerg Med. 2013 31 (5): 792-7

PMID: 23478104 · PMCID: PMC3655117 · DOI:10.1016/j.ajem.2013.01.020

OBJECTIVES - 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.

Copyright © 2013 Elsevier Inc. All rights reserved.

MeSH Terms (16)

Aged Aged, 80 and over Atrial Fibrillation Decision Support Techniques Disease Progression Emergency Service, Hospital Female Follow-Up Studies Health Status Indicators Humans Male Middle Aged Prognosis Retrospective Studies Risk Assessment ROC Curve

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