Comparison of HARMS2-AF score and CHA2DS2-VASc score in prediction of postoperative atrial fibrillation after non- cardiac surgery

Abstract

Presence of postoperative atrial fibrillation (POAF) is associated with increased morbidity and mortality. However, prediction of POAF is limited. We sought to determine whether HARMS₂-AF score and CHA₂DS₂-VASc score was of any predictive value in risk of POAF in patient underwent non-cardiac surgery. We conducted a retrospective study including adult patients in sinus rhythm who underwent non-cardiac surgery and were subsequently admitted to the intensive care unit (ICU) between January 1, 2022, and December 31, 2023. All patients had been continuously monitored with ECG at least 24 hours. Comparison of the efficacy of the HARMS₂-AF score with the CHA₂DS₂-VASc score in predicting postoperative atrial fibrillation is the primary outcome of this study. Logistic regression analysis was performed with HARMS₂-AF score and CHA₂DS₂-VASc score. ROC curve was utilized to assess predictor of POAF. Secondary outcomes were incidence of ischemic stroke, myocardial infarction, arterial thromboembolism or death within 90 days after surgery.

          One hundred and seventy-two patients developed POAF (21 of 172 patients, 12.2%). CHA₂DS₂-VASc score showed higher predictive value comparison to HARMS₂-AF score (AUC 0.79 versus 0.616, respectively p=0.02) and patients with CHA₂DS₂-VASc score ≥ 3  had 8.29 times increased risk of POAF(sensitivity 71.4%, specificity 76.8%). The composite outcome of ischemic stroke, myocardial infarction, arterial thromboembolism, or death within 90 days was significantly higher in the POAF group (38% vs. 26%), underscoring the clinical significance of postoperative atrial fibrillation.

          CHA₂DS₂-VASc score is better than HARMS₂-AF score in prediction of POAF after non-cardiac surgery and the CHA₂DS₂-VASc score is easily for identifying patients at high risk for postoperative atrial fibrillation.