Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Acad Emerg Med. 2013 Feb;20(2):193-9. doi: 10.1111/acem.12078.
Atrial fibrillation is common in the emergency department (ED). Mortality rates at 30, 90, and 365 days for ED patients with a main diagnosis of atrial fibrillation are 4, 6, and 11%, respectively; there are no data on the characteristics and outcomes of ED patients with atrial fibrillation who have alternative primary ED diagnoses.
In this single-site, retrospective cohort study, all electrocardiograms (ECGs) with confirmed atrial fibrillation performed in the ED from April 2007 to March 2008 were identified. Repeat ED visits were excluded. ECGs associated with a primary ED diagnosis of atrial fibrillation were excluded, and from the remaining ECGs of patients with a different primary ED diagnosis, half were randomly selected for abstraction. The main outcome measure was all-cause mortality at 30, 90, and 365 days post-ED visit, derived from linkage to a provincewide mortality database. As a secondary analysis, logistic regression was used to compare 90-day mortality of these patients to those with primary ED diagnoses of atrial fibrillation seen during the same time period.
Of 768 qualifying index ED visits, 416 charts were abstracted. Mean (± standard deviation [SD]) age was 80.3 (± 11.8) years, and 50.7% were female. Two-thirds had a previous history of atrial fibrillation/flutter, 300 (72.1%) had a CHADS2 score ≥ 2, one died in the ED, and 275 (66.1%) were admitted. The most common primary ED diagnoses were congestive heart failure (12%), pneumonia (6%), and chest pain not yet diagnosed (6%), while most common in-hospital diagnoses were congestive heart failure (15%), chronic obstructive pulmonary disease exacerbation (6%), atrial fibrillation (5%), and pneumonia (5%). Mortalities at 30, 90, and 365 days were 10.6% (95% confidence interval [CI] = 7.8% to 14.0%), 17.4% (95% CI = 13.9% to 21.5%), and 34.2% (95% CI = 29.6% to 39.0%), respectively. In the adjusted analysis, an alternative primary ED diagnosis was associated with an increased risk of death (odds ratio [OR] = 2.75; p = 0.01).
Patients seen in the ED with atrial fibrillation and different primary ED diagnoses are older and have high short- and long-term mortality rates: mortality was three times higher than in patients with primary ED diagnoses of atrial fibrillation. Future studies of atrial fibrillation in the ED should distinguish between these two populations and the potential contribution of atrial fibrillation to mortality in the setting of other primary ED diagnoses.
心房颤动在急诊科（ED）中很常见。ED 中主要诊断为心房颤动的患者在 30、90 和 365 天的死亡率分别为 4%、6%和 11%；没有关于 ED 患者的特征和结局的数据，这些患者有其他替代的主要 ED 诊断。
在这项单站点回顾性队列研究中，确定了 2007 年 4 月至 2008 年 3 月期间在 ED 进行的所有确诊为心房颤动的心电图（ECG）。排除重复 ED 就诊。排除与 ED 主要诊断为心房颤动相关的 ECG，并从其余具有不同主要 ED 诊断的患者的 ECG 中随机抽取一半进行提取。主要结局测量指标是 30、90 和 365 天的全因死亡率，来源于全省死亡率数据库的链接。作为二次分析，使用逻辑回归比较了这些患者与同期患有主要 ED 诊断为心房颤动的患者的 90 天死亡率。
在 768 例符合条件的指数 ED 就诊中，有 416 例图表被提取。平均（±标准偏差[SD]）年龄为 80.3（±11.8）岁，女性占 50.7%。三分之二的患者有既往心房颤动/扑动史，300 例（72.1%）患者 CHADS2 评分≥2，1 例在 ED 死亡，275 例（66.1%）住院。最常见的主要 ED 诊断是充血性心力衰竭（12%）、肺炎（6%）和未确诊的胸痛（6%），而最常见的住院诊断是充血性心力衰竭（15%）、慢性阻塞性肺疾病加重（6%）、心房颤动（5%）和肺炎（5%）。30、90 和 365 天的死亡率分别为 10.6%（95%置信区间[CI]为 7.8%至 14.0%）、17.4%（95% CI 为 13.9%至 21.5%）和 34.2%（95% CI 为 29.6%至 39.0%）。在调整分析中，替代主要 ED 诊断与死亡风险增加相关（比值比[OR] = 2.75；p = 0.01）。
在 ED 就诊的患有心房颤动和不同主要 ED 诊断的患者年龄较大，且短期和长期死亡率较高：死亡率比患有主要 ED 诊断为心房颤动的患者高 3 倍。ED 中心房颤动的未来研究应区分这两种人群，以及在其他主要 ED 诊断的情况下，心房颤动对死亡率的潜在影响。
