Detecting Atrial Fibrillation in the Emergency Department in Patients with Cardiac Implantable Electronic Devices
| Autor: | Eric Carda, Jack Mardekian, Peter Belott, Jeffrey Trocio, Terri Craig, Kristina L. Greenwood, Divina Fanning, Patricia L. McNamee, Matthew D Pugh, Besa Smith |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty 030204 cardiovascular system & hematology Asymptomatic California 03 medical and health sciences 0302 clinical medicine Risk Factors Atrial Fibrillation medicine Humans 030212 general & internal medicine Stroke Aged Retrospective Studies Point of care Aged 80 and over business.industry Medical record Retrospective cohort study Atrial fibrillation Emergency department Middle Aged medicine.disease Defibrillators Implantable Heart failure Emergency medicine Emergency Medicine Female medicine.symptom Emergency Service Hospital business |
| Zdroj: | The Journal of Emergency Medicine. 57:437-443 |
| ISSN: | 0736-4679 |
| DOI: | 10.1016/j.jemermed.2019.06.029 |
| Popis: | Background Clinical guidelines emphasize identifying atrial fibrillation (AF) as a strategy to reduce stroke risk. Cardiac implantable electronic device (CIED) interrogation at the point of care may facilitate AF detection, increasing opportunities to identify patients at high risk for stroke. Objectives This study sought to quantify AF prevalence and assess stroke risk in patients with a CIED who presented to the emergency department (ED). Methods This noninterventional, retrospective observational study included adult patients who presented at a single facility ED that incorporated device interrogation as a routine standard practice for all patients with a CIED. Interrogations were conducted in 494 unique patients, and relevant demographic/clinical information was captured from electronic medical records. Results AF was detected via CIED interrogation in 54.8% (271/494) of the unique patient population that presented to the ED. Device interrogation detected the presence of AF in 110 patients without a documented past history or current diagnosis of AF, representing 22.3% (110/494) of total unique patients. Based on CHA2DS2-VASc (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65-74 years, Sex category [female]) risk scoring methodology, over three-quarters of these newly detected AF patients (78.2%, 86/110) were classified in a high stroke risk category that reflected a > 2.2% annualized risk, and over half (57.3%, 63/110) presented to the ED for reasons unrelated to cardiac/dysrhythmia problems. Conclusions The use of technology-assisted device interrogation of CIEDs at the point of care has promise in identifying patients with asymptomatic AF. Results suggest consideration of routine device interrogation of CIEDs in the ED, regardless of reason for admission or history of AF. |
| Databáze: | OpenAIRE |
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