Factors associated with poor prognosis in patients with atrial fibrillation: An emergency department perspective the EMERG-AF study |
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| Institution: | 1. Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Spain;2. Emergency Department, Hospital Universitario de Basurto, Spain;3. Emergency Department, Hospital Clínic, IDIBAPS, Unitat de Fibril·lació Auricular, University of Barcelona, Spain;4. Emergency Department, Hospital Universitario de Móstoles, Madrid, Spain;5. Emergency Department, Hospital General de Alicante, Spain;6. Emergency Department, Hospital Universitario Virgen de las Nieves, Granada, Spain;7. Department of Pharmacology, CIBERCV, Universidad Complutense, Madrid;8. Emergency Department, Hospital Universitario de Donostia, Spain;9. Emergency Department, Hospital Universitario Río Hortega, Valladolid, Spain;10. Emergency Department, Hospital Universitario La Princesa, Madrid, Spain;11. Laboratory of Biostatistics & Epidemiology, Universitat Autònoma de Barcelona, Hospital Clínic, IDIBAPS, University of Barcelona, Spain;12. Emergency Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain;13. Cardiac Arrhythmia Unit, Hospital Universitario de Basurto, Spain;14. Emergency Department, Hospital de la Axarquía, Málaga, Spain;1. Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China;2. Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom;3. Hepato-pancreato-biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China;4. Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China;1. Division of Pediatric Emergency Medicine, The Children''s Hospital at Montefiore, Bronx, NY, United States of America;2. Division of Academic General Pediatrics, Albert Einstein College of Medicine, Bronx, NY, United States of America;3. Division of Pediatric Infectious Diseases, The Children''s Hospital at Montefiore, Bronx, NY, United States of America |
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| Abstract: | ObjectiveWe sought to identify the factors associated with a worse prognosis in Emergency Department (ED) patients with atrial fibrillation (AF), crucial information to guide management decisions.MethodsThis is a secondary analysis of a prospective, multicenter, observational cohort of consecutive AF patients attended in 62 EDs in Spain. Clinical variables were collected on enrollment. Follow-up was performed at 30 days and one year. The primary composite outcome was all-cause mortality, major bleeding and/or stroke at one year. Secondary outcomes were each of these components considered separately, plus one-year cardiovascular mortality and the composite outcome at 30 days.ResultsWe analyzed 1107 patients. The primary outcome occurred in 209 patients (18.9%), one-year all-cause mortality in 151 (13.6%), major bleeding in 47 (4.2%), and stroke in 31 (2.8%). Disability (HR 2.064, 95% CI 1.478–2.882), previous known AF (HR 1.829, 95% CI 1.096–3.051), long duration of the AF episode (HR 1.849, 95% CI 1.052–3.252) and renal failure (HR 2.073, 95% CI 1.433–2.999) were independently associated with the primary outcome, whereas anticoagulation at discharge was inversely associated (HR 0.576, 95% CI 0.415–0.801). Disability was associated with mortality, cardiovascular mortality, and the composite at 30 days, and renal failure with mortality and major bleeding.ConclusionsComorbidities like renal failure, long AF duration and disability were related to adverse outcomes and should be decisive to guide management decisions in ED patients with AF.Anticoagulation had a positive impact on prognosis and should be the mainstay of therapy in AF patients attended in ED. |
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