Short- and medium-term complications after emergency department treatment of patients with atrial fibrillation: design and internal validation of the CoSTuM risk scale.

Autor:	Valle Alonso J; Servicio de Urgencias, Royal Bournemouth Hospital, Bournemouth, Reino Unido., Rivera-Caravaca JM; Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIBArrixaca), Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Murcia, España. Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, Reino Unido., Fonseca FJ; Servicio de Calidad y Docencia, Hospital de San Juan de Dios, Córdoba, España., Noblía L; Servicio de Urgencias, Hospital Santa Lucia, Cartagena, España., Cruzado J; Servicio de Urgencias, Hospital Santa Lucia, Cartagena, España., Nolasco Bonmati A; Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, Alicante, España.
Jazyk:	English; Spanish; Castilian
Zdroj:	Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias [Emergencias] 2021 Abr; Vol. 33 (2), pp. 85-92.
Abstrakt:	Objectives: To design and validate a clinical risk scale for 90-day adverse events after emergency department (ED) discharge of patients with atrial fibrillation (AF). Material and Methods: Prospective, observational CoSTuM (Spanish acronym for comorbidity, symptoms, treatments, and poor heart rate control) study of patients with AF. We recorded all adverse events occurring during follow-up and used multivariate logistic regression analysis to identify variables independently associated with the occurrence of any such event. A risk model was developed with data from a random sample of 66% of the patients. Data for the remaining patients were used for internal validation of the model. Results: We analyzed data for 645 patients (50.2% women; median [interquartile range] age, 76 (67-81 years). At 90 days, at least 1 adverse event had occurred in 165 patients (25.6%); 114 were in the development sample and 51 were in the validation sample. Independent variables associated with risk for adverse events were age 70 years or older; vascular disease; heart failure; chronic obstructive pulmonary disease; kidney disease; obesity; poorly controlled AF symptoms (European Heart Rhythm Association score, III-IV); use of oxygen therapy, digoxin, or other antiarrhythmics in the ED; and poor control of heart rate. The CoSTuM scale based on these variables demonstrated optimal predictive value in both the development sample (c statistic, 0.901; 95% CI, 0.869-0.928; P .001) and the validation sample (c statistic, 0.850, 95% CI, 0.796-0.894; P .001). Conclusion: The CoSTuM risk score was a good predictor of 90-day adverse events after ED discharge of patients treated for AF.
Databáze:	MEDLINE
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