Almeida Eduardo Dytz, Ley Antonio Lessa Gaudie, de Lima Gustavo Glotz, Saffi Marco Aurélio Lumertz, Leiria Tiago Luiz Luz
Programa de Pós-Graduação em Ciências da Saúde - Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil.
Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
J Electrocardiol. 2019 Sep-Oct;56:109-114. doi: 10.1016/j.jelectrocard.2019.07.011. Epub 2019 Jul 25.
Emergency department (ED) visits due to atrial fibrillation and flutter (AFF) are common, and provide an opportunity to define stroke risk. The prognostic impact of AFF duration on return ED visits is unknown. We aimed to investigate both the prognostic impact of AFF classification on ED visits and the adherence to guideline recommendations on anticoagulation.
This single-center historic cohort of every patient treated for AFF in our ED during 2012. Follow-up data was obtained on May 2015 (median follow-up of 863 days).
Among 1112 patients (495 Paroxysmal AF - parAF, 475 Persistent AF - persAF, and 142 flutter), those with parAF were less frequently under oral anticoagulation than persAF and flutter patients (15.8%, 39.4%, 40.1%, p < 0.01). Mean CHA2DS2-VASc scores of parAF were lower than persAF (2.2 vs. 3.12, p < 0.01), and did not differ from those with flutter. Return visits to the ED were highest among flutter patients and lowest among parAF (49.3% vs. 37.2%, p < 0.01). Heart failure, hypertension, female gender and atrial flutter were independent risk factors for repeated visits on multivariate regression.
AFF duration provide prognostic information in the ED. ED return visits were common and particularly incident among flutter patients. Furthermore, stroke risk was high and anticoagulation rates were low across all groups. Patients with paroxysmal AF were less commonly anticoagulated even though their mean CHA2DS2-VASc scores were 2.2. These results reveal that guideline adherence is still lacking and should raise awareness to a stricter patient follow-up after ED visits.
因心房颤动和扑动（AFF）而到急诊科（ED）就诊很常见，这为确定中风风险提供了契机。AFF持续时间对再次到ED就诊的预后影响尚不清楚。我们旨在研究AFF分类对ED就诊的预后影响以及对抗凝指南建议的遵循情况。
这是一项单中心历史性队列研究，纳入了2012年在我们急诊科接受AFF治疗的每一位患者。随访数据于2015年5月获取（中位随访时间为863天）。
在1112例患者中（495例阵发性房颤 - parAF，475例持续性房颤 - persAF，142例心房扑动），parAF患者接受口服抗凝治疗的频率低于persAF和心房扑动患者（分别为15.8%、39.4%、40.1%，p<0.01）。parAF的平均CHA2DS2-VASc评分低于persAF（2.2对3.12，p<0.01），与心房扑动患者的评分无差异。心房扑动患者再次到ED就诊的比例最高，parAF患者最低（49.3%对37.2%，p<0.01）。在多因素回归分析中，心力衰竭、高血压、女性性别和心房扑动是再次就诊的独立危险因素。
AFF持续时间在急诊科提供了预后信息。再次到ED就诊很常见，尤其是在心房扑动患者中。此外，所有组的中风风险都很高，抗凝率很低。阵发性房颤患者即使平均CHA2DS2-VASc评分为2.2，接受抗凝治疗的情况也较少。这些结果表明，仍然缺乏对指南的遵循，应提高对ED就诊后更严格患者随访的认识。
