Key result
Four bedside predictive indices (-VASC, HATCH, and POAF scores) demonstrated poor discriminative ability for predicting postoperative atrial fibrillation (AUC-ROC ranging from 0.49 to 0.52).
Why the study?
Postoperative atrial fibrillation is a common complication after cardiac surgery associated with adverse outcomes, and comparing the discriminative ability of four bedside predictive indices was needed.
Do four bedside predictive indices accurately predict new onset postoperative atrial fibrillation in cardiac surgery patients?
Cohort (n=2,465)
No
Do four bedside predictive indices accurately predict new onset postoperative atrial fibrillation in cardiac surgery patients?
Effect estimate: AUC-ROC 0.49, 0.49, 0.50, 0.52
Four previously validated bedside predictive indices for postoperative atrial fibrillation demonstrated poor discriminative ability in a large Australian cardiac surgery cohort, highlighting limited generalizability.
Bedside scores lack accuracy for postoperative AF prediction; leaves open need for novel validated tools in cardiac surgery.
BACKGROUND: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, leading to increased mortality, morbidity, and length of stay. Various predictive indices have been validated to identify patients at risk of developing POAF. This study aimed to compare the discriminative ability of four bedside indices that predict POAF in cardiac surgical patients. METHOD: A total of 2465 consecutive patients who underwent cardiac surgery at an Australian tertiary hospital between 29 December 2015, and 31 December 2022, were retrospectively analysed. Exclusion criteria included pre-existing atrial fibrillation and transcatheter interventions. The area under the receiver-operating characteristic curve (AUC-ROC) analysis and Hosmer-Lemeshow calibration were performed to compare discriminative abilities. A logistic regression model was constructed to evaluate independent risk factors for developing POAF. RESULTS: -VASC, HATCH and POAF scores had weak discrimination and demonstrated poor predictive ability in this cohort (AUC-ROC 0.49, 0.49, 0.50, 0.52, respectively). CONCLUSION: Although previously validated in various cohorts, the four bedside predictive indices demonstrated poor discriminative ability and limited generalizability to our tertiary-hospital cohort.
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Chang et al. (2025) conducted a cohort in Postoperative atrial fibrillation after cardiac surgery (n=2,465). Four bedside predictive indices (-VASC, HATCH, and POAF scores) was evaluated on Discriminative ability for predicting postoperative atrial fibrillation (AUC-ROC 0.49, 0.49, 0.50, 0.52). Four bedside predictive indices (-VASC, HATCH, and POAF scores) demonstrated poor discriminative ability for predicting postoperative atrial fibrillation (AUC-ROC ranging from 0.49 to 0.52).
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