Factors associated with poor prognosis in patients with atrial fibrillation: An emergency department perspective the EMERG-AF study - 30/11/21
on behalf of the
EMERG-AF investigators (Appendix 1)
Abstract |
Objective |
We 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.
Methods |
This 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.
Results |
We 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.
Conclusions |
Comorbidities 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.
Le texte complet de cet article est disponible en PDF.Keywords : Atrial fibrillation, Clinical factors, Emergency department, Prognosis
Plan
Vol 50
P. 270-277 - décembre 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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