Santini Massimo, De Ferrari Gaetano M, Pandozi Claudio, Alboni Paolo, Capucci Alessandro, Disertori Marcello, Gaita Fiorenzo, Lombardi Federico, Maggioni Aldo P, Mugelli Alessandro, Salerno-Uriarte Jorge A, Sermasi Sergio, Schwartz Peter J
Department of Cardiology, San Filippo Neri Hospital, Rome, Italy.
Ital Heart J. 2004 Mar;5(3):205-13.
The atrial Fibrillation/flutter Italian REgistry (FIRE) study was designed to obtain updated information regarding the clinical characteristics of and medical approach to patients requiring urgent medical care for atrial fibrillation (AF) or atrial flutter in a nationwide and representative series of hospitals.
4570 consecutive patients admitted to the emergency room for AF/atrial flutter were enrolled in 207 hospitals. Of these, 2838 (61.9%) were hospitalized (median 6 days, 43% in cardiology and 57% in internal medicine departments), and constitute the population of this study.
AF/atrial flutter represented 1.5% of all emergency room admissions and 3.3% of all hospitalizations. The mean age was 70 +/- 12 years; 89.9% had AF and 10.1% atrial flutter. In 31% of the hospitalized patients no cardiac disease was present, and in 18% no disease (either cardiac or non-cardiac) could be detected. Predictors of no attempt of cardioversion (37.5% of patients) included: onset of AF > 48 hours, heart failure, increasing age, syncope, admission to a non-cardiology department, stroke or transient ischemic attack (TIA). Predictors of in-hospital mortality (2.2%) included: age, heart failure, diabetes, admission to a non-cardiology department, and stroke or TIA. Predictors of the absence of sinus rhythm at discharge (35.6% of patients) included: no attempt of cardioversion, heart failure, chronic anticoagulation, AF duration > 48 hours, increasing age, stroke or TIA, and admission to a non-cardiology department. Transesophageal echocardiography was performed in only 6% of patients.
AF/atrial flutter represent a significant burden on the health care system with a higher than expected hospitalization rate from the emergency room. One out of three discharged patients is not in sinus rhythm. There is still a wide gap between evidence-based medicine and real practice in the treatment of patients with AF.
心房颤动/心房扑动意大利注册研究（FIRE）旨在获取关于在全国范围内具有代表性的一系列医院中因心房颤动（AF）或心房扑动而需要紧急医疗护理的患者的临床特征和医疗方法的最新信息。
207家医院连续纳入了4570例因AF/心房扑动入住急诊室的患者。其中，2838例（61.9%）住院（中位住院时间6天，43%在心脏病科，57%在内科），构成了本研究的人群。
AF/心房扑动占所有急诊室入院病例的1.5%，占所有住院病例的3.3%。平均年龄为70±1岁；89.9%为AF，10.1%为心房扑动。31%的住院患者无心脏病，18%未检测到疾病（心脏病或非心脏病）。未尝试复律（37.5%的患者）的预测因素包括：AF发作>48小时、心力衰竭、年龄增加、晕厥、入住非心脏病科、中风或短暂性脑缺血发作（TIA）。住院死亡率（2.2%）的预测因素包括：年龄、心力衰竭、糖尿病、入住非心脏病科以及中风或TIA。出院时无窦性心律（35.6%的患者）的预测因素包括：未尝试复律、心力衰竭、长期抗凝、AF持续时间>48小时、年龄增加、中风或TIA以及入住非心脏病科。仅6%的患者进行了经食管超声心动图检查。
AF/心房扑动给医疗保健系统带来了沉重负担，急诊室住院率高于预期。三分之一出院患者无窦性心律。在AF患者的治疗中，循证医学与实际临床实践之间仍存在很大差距。
