Prognostic analysis of emergency department patients with atrial fibrillation≥75 years old—a subgroup analysis of the Chinese Emergency Atrial Fibrillation Study / 中华急诊医学杂志

ABSTRACT

Objective:To investigate the baseline characteristics and 1-year follow-up prognosis of elderly (age ≥75 years) emergency department (ED) patients with atrial fibrillation (AF).Methods:From 2009 to 2011, patients with AF aged ≥75 years were continuously enrolled in the ED in 20 hospitals. The baseline characteristics and treatment status of the patients were collected and followed up for 1 year. The primary endpoint was all-cause death; Secondary endpoints were cardiovascular death, stroke, major bleeding and major adverse events. Uni- and multivariate Cox regression models were used to analyze the independent risk factors for the above events.Results:A total of 766 elderly ED patients with AF were enrolled, the average age was 80.76±4.66 years old, and 56.9% were female. The 1-year all-cause mortality was 24.3%, cardiovascular mortality was 12.8%, stroke rate was 10.6%, major adverse event rate was 33.6%, and the readmission rate was 32%. Multivariate Cox regression analysis showed that age ( HR1.073, 95% CI 1.042-1.105), heart rate ( HR1.008, 95% CI 1.002-1.013), history of dementia/cognitive impairment ( HR1.849, 95% CI 1.016) ~3.365), and history of chronic obstructive pulmonary disease ( HR1.824, 95% CI 1.303-2.551) were independent risk factors for death in elderly patients with AF in 1-year follow-up; female (HR1.664, 95% CI 1.036-2.675), and history of hypertension ( HR2.035, 95% CI 1.080-3.836), history of dementia/cognitive impairment ( HR2.773, 95% CI 1.220-6.302) were independent risk factors for 1-year stroke in elderly patients with AF. Conclusions:The prognosis of elderly ED patients with AF is poor. Age, heart rate, history of dementia/cognitive impairment, and history of chronic obstructive pulmonary disease are independent risk factors for 1-year all-cause death and major adverse events in elderly ED patients with AF. Female, history of hypertension, and history of dementia/ cognitive impairment are independent risk factors for stroke in elderly ED patients with AF.