Factors associated with poor prognosis in patients with atrial fibrillation: An emergency department perspective the EMERG-AF study
| Autor: | Amparo Fernández-Simón, Blanca Coll-Vinent, José Ormaetxe, José Ríos, Emerg-Af investigators, Juan Tamargo, Coral Suero, Alfonso Martín, Juan M Sanchez, Carmen Del Arco, Susana Sánchez, Manuel Cancio, Mercedes Varona, José Carbajosa |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Poor prognosis medicine.medical_specialty Hemorrhage Risk Factors Cause of Death Internal medicine Atrial Fibrillation medicine Humans In patient Prospective Studies Stroke Aged Aged 80 and over business.industry Atrial fibrillation General Medicine Emergency department Prognosis medicine.disease Cohort Emergency Medicine Female Observational study Emergency Service Hospital business Major bleeding |
| Zdroj: | The American Journal of Emergency Medicine. 50:270-277 |
| ISSN: | 0735-6757 |
| DOI: | 10.1016/j.ajem.2021.07.055 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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