Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 11, 2018
Open Peer Review Period: Nov 11, 2018 - Nov 21, 2018
Date Accepted: Jan 13, 2019
(closed for review but you can still tweet)
Assessment of CHA2DS2-VASc Score for the Risk Stratification of Hospital Admission in Patients with Cardiovascular Diseases Receiving a Fourth-Generation Synchronous Telehealth Program
ABSTRACT
Background:
The telehealth program is diverse with mixed results. A comprehensive and integrated approach is needed to evaluate who gets benefits from the program to improve clinical outcomes.
Objective:
The CHA2DS2-VASc score has been widely used for the prediction of stroke in patients with atrial fibrillation. This study adopts the predictive concept of the CHA2DS2-VASc score and investigated this score for risk stratification in hospital admission in patients with cardiovascular diseases receiving a fourth-generation synchronous telehealth program.
Methods:
This was a retrospective cohort study. We recruited patients with cardiovascular disease who received the fourth-generation synchronous telehealth program at the National Taiwan University Hospital between October 2012 and June 2015. We enrolled 431 patients who had joined a telehealth program and compared them with 1549 control patients. Cardiovascular hospitalization was estimated with Kaplan-Meier curves. The CHA2DS2-VASc score was used as the composite parameter to stratify the severity of the patients. The association between baseline characteristics and the clinical outcomes was assessed via the Cox proportional hazard model.
Results:
The mean follow-up duration was 886.1 ± 531.0 days in patients receiving the fourth-generation synchronous telehealth program and 707.1 ± 431.4 days in the control group. (p<0.0001). The telehealth group had more comorbidities at baseline than the control group. Patients with higher CHA2DS2-VASc score (≥ 4) were associated with a lower estimated rate of free from cardiovascular hospitalization (46.5% vs. 54.8%, log-rank test p = 0.0028). Patients receiving the telehealth program with CHA2DS2-VASc score ≥ 4 were less likely to be admitted for cardiovascular disease (61.5% vs. 41.8%, log-rank test p = 0.010). The telehealth program remains a significant prognostic factor after multivariable Cox analysis in patients with CHA2DS2-VASc score ≥ 4 (HR=0.36 [CI: 0.22 -0.62], p < 0.0001)
Conclusions:
A higher CHA2DS2-VASc score is associated with higher cardiovascular admission. Patients with CHA2DS2-VASc ≥4 benefits most for free from cardiovascular hospitalization after accepting the fourth-generation telehealth program. Clinical Trial: N/A
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