A Clinical Decision Instrument for 30-Day Death After an Emergency Department Visit for Atrial Fibrillation: The Atrial Fibrillation in the Emergency Room (AFTER) Study

Study objective The high volume of patients treated in an emergency department (ED) for atrial fibrillation is predicted to increase significantly in the next few decades. Currently, 11% of these patients die within a year. We sought to derive and validate a complex model and a simplified model that...

Full description

Saved in:
Bibliographic Details
Published in:Annals of emergency medicine 2015-12, Vol.66 (6), p.658-668.e6
Main Authors: Atzema, Clare L., MD, MSc, Dorian, Paul, MD, MSc, Fang, Jiming, PhD, Tu, Jack V., MD, PhD, Lee, Douglas S., MD, PhD, Chong, Alice S., BSc, Austin, Peter C., PhD
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged, 80 and over
Atrial Fibrillation - complications
Atrial Fibrillation - diagnosis
Atrial Fibrillation - mortality
Atrial Fibrillation - therapy
Blood Pressure
Chest Pain - mortality
Decision Support Techniques
Emergency
Emergency Service, Hospital - statistics & numerical data
Female
Heart Failure - complications
Heart Failure - mortality
Heart Rate
Humans
Male
Ontario - epidemiology
Pulmonary Disease, Chronic Obstructive - complications
Pulmonary Disease, Chronic Obstructive - mortality
Retrospective Studies
Risk Assessment - methods
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Study objective The high volume of patients treated in an emergency department (ED) for atrial fibrillation is predicted to increase significantly in the next few decades. Currently, 11% of these patients die within a year. We sought to derive and validate a complex model and a simplified model that predicts mortality in ED patients with atrial fibrillation. Methods This population-based, retrospective cohort study included 3,510 adult patients with a primary diagnosis of atrial fibrillation who were treated at 24 hospital EDs in Ontario, Canada, between April 2008 and March 2009. The main outcome was 30-day all-cause mortality. Results In the derivation cohort (n=2,343; mean age 68.8 years), 2.6% of patients died within 30 days of the ED visit versus 2.7% in the validation cohort (n=1,167; mean age 68.3 years). Variables associated with mortality in the complex model included age, presenting pulse rate and systolic blood pressure, presence of chest pain, 2 laboratory results (positive troponin result and creatinine level greater than 200 μmol [2.26 mg/dL]), 4 comorbidities (smoking, chronic obstructive pulmonary disease, cancer, and dementia), an increased bleeding risk, and a second acute ED diagnosis (in addition to atrial fibrillation). Observed 30-day mortality in the 5 risk strata that were defined by the predicted probability of death were 0.44%, 0.41%, 0.23%, 1.61%, and 10.3%. The c statistics were 0.88 and 0.87 in the derivation and validation cohorts, respectively. The a priori–selected 6-variable model, TrOPs-BAC, included a positive Troponin result, Other acute ED diagnosis, Pulmonary disease (chronic obstructive pulmonary disease), Bleeding risk, Aged 75 years or older, and Congestive heart failure. The c statistic for the simplified model was 0.81 in both the derivation and validation cohorts. Conclusion Using a population-based sample, we derived and validated both a complex and a simplified instrument that predicts mortality after an emergency visit for atrial fibrillation. These may aid clinicians in identifying high-risk patients for hospitalization while safely discharging more patients home.
ISSN:0196-0644
1097-6760
DOI:10.1016/j.annemergmed.2015.07.017