European journal of emergency medicine : official journal of the European Society for Emergency Medicine · 2021
Association between acute heart failure and major cardiovascular events in atrial fibrillation patients presenting at the emergency department: an EMERG-AF ancillary study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Coll-Vinent Blanca, Varona Mercedes, Martin Alfonso, Carbajosa José, Sánchez Juan, Tamargo Juan, Cancio Manuel, Sánchez Susana, Del Arco Carmen, Miró Òscar, Ríos José, García Ana, Fernández-Simón Amparo, Miota Natalia, Suero Coral, EMERG-AF investigators (Appendix 1)
Аннотация
BACKGROUND: There is little evidence concerning the impact of acute heart failure (AHF) on the prognosis of atrial fibrillation patients attending the emergency department (ED).
OBJECTIVE: To know the influence of AHF on adverse long-term outcomes in patients presenting with atrial fibrillation in ED.
DESIGN, SETTING AND PARTICIPANTS: Secondary analysis of a prospective, multicenter, observational cohort of consecutive atrial fibrillation patients, performed in 62 Spanish EDs.
EXPOSURE: Patients presenting with atrial fibrillation in ED were divided by the presence or absence of AHF at arrival.
OUTCOME MEASURES AND ANALYSIS: Primary outcome: combination of 1-year all-cause mortality, major bleeding, stroke and other major cardiovascular events (MACE). Secondary outcomes: each of these events analyzed separately. Cox and logistic regression were used to investigate adjusted significant associations between AHF and outcomes.
MAIN RESULTS: Totally, 1107 consecutive ED patients with atrial fibrillation attending ED were analyzed, 262 (23.7%) with AHF. The primary outcome occurred in 433 patients (39.1%), 1-year all-cause mortality in 151 patients (13.6%), major bleeding in 47 patients (4.2 %), stroke in 31 patients (2.8 %) and other MACE in 333 patients (30.1%). AHF was independently related to the primary outcome [odds ratio (OR), 1.422; 95% confidence interval (CI), 1.020-1.981; P = 0.037)] and 1-year MACE (OR, 1.797; 95% CI, 1.285-2.512; P = 0.001), but not to 1-year all-cause mortality, stroke or bleeding.
CONCLUSIONS: The coexistence of AHF in patients presenting with atrial fibrillation in ED is associated to a worse 1-year outcome mainly due to MACE, but does not impact in overall mortality.
OBJECTIVE: To know the influence of AHF on adverse long-term outcomes in patients presenting with atrial fibrillation in ED.
DESIGN, SETTING AND PARTICIPANTS: Secondary analysis of a prospective, multicenter, observational cohort of consecutive atrial fibrillation patients, performed in 62 Spanish EDs.
EXPOSURE: Patients presenting with atrial fibrillation in ED were divided by the presence or absence of AHF at arrival.
OUTCOME MEASURES AND ANALYSIS: Primary outcome: combination of 1-year all-cause mortality, major bleeding, stroke and other major cardiovascular events (MACE). Secondary outcomes: each of these events analyzed separately. Cox and logistic regression were used to investigate adjusted significant associations between AHF and outcomes.
MAIN RESULTS: Totally, 1107 consecutive ED patients with atrial fibrillation attending ED were analyzed, 262 (23.7%) with AHF. The primary outcome occurred in 433 patients (39.1%), 1-year all-cause mortality in 151 patients (13.6%), major bleeding in 47 patients (4.2 %), stroke in 31 patients (2.8 %) and other MACE in 333 patients (30.1%). AHF was independently related to the primary outcome [odds ratio (OR), 1.422; 95% confidence interval (CI), 1.020-1.981; P = 0.037)] and 1-year MACE (OR, 1.797; 95% CI, 1.285-2.512; P = 0.001), but not to 1-year all-cause mortality, stroke or bleeding.
CONCLUSIONS: The coexistence of AHF in patients presenting with atrial fibrillation in ED is associated to a worse 1-year outcome mainly due to MACE, but does not impact in overall mortality.