Emergency Department capacity to initiate thromboprophylaxis in patients with atrial fibrillation and thrombotic risk after discharge: URGFAICS cohort analysis.

Atrial fibrillation (AF) is the most prevalent heart rhythm disorder in the general population. Stroke prevention is one of the leading management objectives in the treatment of AF patients. The variables associated with the non-initiation of thromboprophylaxis in patients with thrombotic risk consulting for an episode of AF in Emergency Departments (ED) were investigated. This was a multipurpose, analytical, non-interventionist, multicenter Spanish study with a prospective 30-day follow-up. All patients ≥ 18 years of age consulting to the ED for the casual finding of AF in an electrocardiogram (ECG) performed 12 h prior to the consultation or with symptoms related to AF were enrolled from September 1, 2016 to February 28, 2017. Patients not previously received thromboprophylaxis were selected. Multivariate analysis was performed to calculate the odds ratio (OR) and the 95% confidence interval (CI). A total of 634 patients, not received thromboprophylaxis and at high thrombotic risk, were included. Of these, 251 (39.6%) did not receive thromboprophylaxis at ED discharge. In the multivariate analysis, non-initiation of anticoagulation at discharge from the ED was mostly related to cognitive impairment (OR 3.95; (95% CI 2.02-7.72), cancer history (OR 2.12; (95%CI 1.18-3.81), AF duration < 48 h (OR 2.49; (95% CI 1.48-4.21) and patients with re-establishment of sinus rhythm (OR 3.65; (95% CI 1.47-9.06). Reinforcement of the use of CHA2DS2-VASC as a stroke risk scale and empowerment of ED physicians is a must to improve this gap in care.

Registro de fibrilación auricular en servicios de urgencias del Institut Català de la Salut (URGFAICS): análisis en función del tipo de fibrilación auricular y de la reconsulta a urgencias relacionada a los 30 días / Emergency Atrial Fibrillation Registry of the Catalan Institute of Health (URGFAICS): analysis by type of atrial fibrillation and revisits within 30 days

Objetivos: Estudiar las características de los pacientes que consultan por un episodio de fibrilación auricular (FA) en los servicios de urgencias hospitalarios (SUH), en función de si la FA es de novo o conocida previamente, y la reconsulta relacionada con la FA a los 30 días (R30d). Método: Estudio observacional de cohorte prospectivo y multicéntrico que incluyó a todos los pacientes ≥ 18 años que consultaron por síntomas relacionados con una FA o el hallazgo de una FA en 5 SUH catalanes. Se recogieron variables demográficas, del episodio agudo, de manejo en urgencias y la R30d. Resultados: De los 1.199 pacientes, 1.052 tuvieron seguimiento a 30 días. La edad media fue de 73 (DE 13) años y 646 (53,9%) eran mujeres. Seiscientos cincuenta y dos pacientes (54,4%) tenían una FA conocida, los cuales tenían mayor edad, presencia de comorbilidades y uso de antiarrítmicos y anticoagulantes orales. Hubo escasas diferencias en el manejo farmacológico en urgencias. La R30d fue de un 7,9%, y fue más frecuente cuando se usó digoxina en urgencias y bloqueadores de los canales del calcio al alta. Conclusiones: Existen diferencias basales entre los pacientes con FA de novo y conocida, pero estas son escasas en el manejo en urgencias. En pacientes atendidos por fibrilación auricular en urgencias, la R30d se relacionó con el uso de digoxina en urgencias y de bloqueadores de los canales del calcio al alta

Objectives: To study the characteristics of patients attending a hospital emergency department (ED) with de novo or previously diagnosed atrial fibrillation (AF), and to determine the rate of revisits for AF within 30 days of discharge. Methods: Prospective multicenter, observational cohort study of patients aged 18 years or older who came to 5 Catalan EDs with symptoms of AF or who were found to have AF on examination. We recorded demographic information and data related to the acute episode and ED management on the first or other visits within 30 days. Results: We had complete follow-up data for 1052 of the 1199 patients initially registered. The mean (SD) age was 73 (13) years, and 646 (53.9%) were women. AF had already been diagnosed in 652 (54.4%). Patients with diagnosed AF were older, had more concomitant conditions, and were more likely to be taking antiarrhythmic and/or anticoagulant drugs. Pharmacologic management in the ED was similar. The 30-day revisiting rate was 7.9% , and revisits were more frequent when digoxin was used in the ED and/or calcium channel blockers were prescribed on discharge. Conclusions: We detected differences between ED patients with de novo FA and previously diagnosed FA, but management of the 2 groups was similar. The 30-day revisiting rate was associated with use of digoxin in the ED and the prescription of calcium channel blockers on discharge