Grupo de Arritmias Cardiacas y Síncope, Sociedad Española de Medicina de Urgencias y Emergencias. Servicio de Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España.
Grupo de Arritmias Cardiacas y Síncope, Sociedad Española de Medicina de Urgencias y Emergencias. Servicio de Urgencias, Hospital Universitario de Móstoles, Madrid, España.
Emergencias. 2022 Apr;34(2):111-118.
The maintenance of sinus rhythm by means of antiarrhythmic drugs and/or upstream therapy to counter cardiac remodeling is fundamental to the management of atrial fibrillation (AF). This study aimed to analyze this approach and its appropriateness in the setting of hospital emergency departments.
Secondary analysis of data from the multicenter observational cross-sectional HERMES-AF study carried out in 124 hospitals representative of the Spanish national health service in 2011. Included were consecutive patients with AF restored to sinus rhythm who were discharged home from emergency care.
A total of 449 patients were included; 204 (45.4%) were already on sinus rhythm maintenance therapy. Of ,the 245 remaining patients, 107 (43.67%) were prescribed maintenance treatment in the emergency department, as follows: 41, an antiarrhythmic drug; 19, upstream therapy; and 49, both treatments. The selection of an antiarrhythmic drug did not follow guideline recommendations in 10 patients (11.8%). Antiarrhythmic drug prescription was associated with having had a prior episode of AF (odds ratio [OR], 2.024; 95% CI, 1.196-3.424; P = .009); a heart rate of more than 110 beats/min (OR, 2.147; 95% CI, 1.034-4.456, P = 0.40); and prescription of anticoagulation on discharge (OR, 1.862; 95% CI, 1.094-3.170; P = .022). Upstream therapy prescription was associated only with a heart rate over 110 beats/min (OR, 2.187; 95% CI, 1.005-4.757; P = .018). In total, 311 patients (69.23%) were discharged from the emergency department with sinus rhythm maintenance therapy: 87 with an antiarrhythmic drug, 117 with an upstream therapy, and 107 with both.
Treatment to prevent the recurrence of AF is underprescribed in emergency departments. Increasing such prescription and ensuring the appropriateness of antiarrhythmic therapy prescribed are points emergency departments can improve in the interest of better sinus rhythm maintenance.
通过抗心律失常药物和/或上游治疗来维持窦性心律以对抗心脏重构，这对于心房颤动（AF）的管理至关重要。本研究旨在分析这种方法及其在医院急诊科的适用性。
对 2011 年在代表西班牙国家卫生服务的 124 家医院进行的多中心观察性横断面 HERMES-AF 研究的数据进行二次分析。纳入的是从急诊出院并恢复窦性心律的连续 AF 患者。
共纳入 449 例患者；204 例（45.4%）已经接受维持窦性节律治疗。在其余 245 例患者中，107 例（43.67%）在急诊科开具维持治疗处方，如下：41 例使用抗心律失常药物；19 例使用上游治疗；49 例同时使用两种治疗方法。在 10 例患者（11.8%）中，抗心律失常药物的选择未遵循指南建议。抗心律失常药物的处方与先前发生 AF 有关（比值比 [OR]，2.024；95%置信区间 [CI]，1.196-3.424；P =.009）；心率超过 110 次/分钟（OR，2.147；95%CI，1.034-4.456，P =.40）；出院时开具抗凝治疗（OR，1.862；95%CI，1.094-3.170，P =.022）。上游治疗的处方仅与心率超过 110 次/分钟有关（OR，2.187；95%CI，1.005-4.757；P =.018）。共有 311 例（69.23%）患者从急诊科出院时开具维持窦性节律的治疗处方：87 例使用抗心律失常药物，117 例使用上游治疗，107 例同时使用两种药物。
急诊科预防 AF 复发的治疗不足。增加这种处方并确保开具的抗心律失常治疗的适当性是急诊科可以改进的地方，以更好地维持窦性节律。
