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ORIGINAL ARTICLE   Open accessopen access

Italian Journal of Emergency Medicine 2022 August;11(2):104-11

DOI: 10.23736/S2532-1285.22.00145-8

Copyright © 2022 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.

language: English

One-year prognosis of patients evaluated in the emergency department for atrial fibrillation at low risk according to the CHA2DS2-VASc Score

Peiman NAZERIAN 1 , Ulisse TONDI 1, Enrico LUMINI 1, Barbara PALADINI 1, Francesca INNOCENTI 2, Francesca CALDI 1, Maurizio ZANOBETTI 2, Caterina CENCI 1, Stefano GRIFONI 1, Riccardo PINI 2

1 Department of Emergency Medicine, Careggi University Hospital, Florence, Italy; 2 High-Dependency Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital, Florence, Italy

BACKGROUND: The ESC 2016 and ACC-AHA 2014 updated in 2019 guidelines for atrial fibrillation (AF) management, stratify patients according to the CHA2DS2-VASc score. In patient at lower risk they suggested an accurate evaluation of the risk factors and willing of the patient before starting anticoagulation therapy. The place and timing of this evaluation vary from hospital to hospital, the approach of the emergency department (ED) of the Azienda Ospedaliera Universitaria di Careggi (AOUC) was not yet described in literature: the patient was offered a visit within three weeks, in an AF outpatient clinic managed by ED physicians. The aim of the study was to evaluate one-year thromboembolic and hemorrhagic events incidence in a cohort of low risk patients evaluate in the AF clinic.
METHODS: Among patients evaluate from 2008 to 2017 those with a CHA2DS2-VASc of 0 or 1 (0 risk factors), 1 and 2 in women (1 risk factors) were selected and underwent a structured phone interview and hospital records search to identify thromboembolic and hemorrhagic events within one year. Our results were compared with those present in literature.
RESULTS: The patients in anticoagulation therapy in our cohort was 12% among patients with 0 risk factors and 27% in patients with one risk factor. In the first group there were no thromboembolic and hemorrhagic events while in the second group thromboembolic and hemorrhagic events incidence were 0.9% and 1.4% respectively. Four patients died, non for ischemic or hemorrhagic causes. Sex, thromboembolic risk factors, age, HASBLED Score of our cohort was similar to other cohort reported in literature. Anticoagulated patients were higher in other cohorts (~50% in 0 risk factors and ~65% in 1 risk factor group) while thromboembolic events were similar or lower (~0.5% in 0 risk factors and ~1.8% in 0 risk factors group) compared with our cohort.
CONCLUSIONS: The conservative approach of the AF clinic of the AOUC (with lower rate of anticoagulation) seems to be appropriate, considering similar or lower thromboembolic events incidence compare to other cohorts.

KEY WORDS: Atrial fibrillation; Emergency department; Prognosis

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