Prevalence of validated risk factors for developing atrial fibrillation--can we identify high-risk ED patients?

Abstract

Objective: The aim of this study was to investigate whether emergency department (ED) patients who were newly diagnosed with atrial fibrillation (AF) displayed risk factors for incident AF on prior ED visits.

Methods: This was a secondary analysis of a retrospective cohort study of ED patients with symptomatic AF at a tertiary referral center. We selected patients who were newly diagnosed with AF between July 1, 2005, and August 31, 2008, and had at least 1 ED visit before their diagnosis. We calculated the Framingham Heart Study AF risk score for each visit by documenting the presence of the risk factors (age, sex, body mass index, systolic blood pressure, hypertension treatment, PR interval, and ages of clinically significant cardiac murmur and heart failure diagnosis).

Results: Of the 296 patients newly diagnosed with AF, 115 (39%) had at least 1 prior ED visit resulting in 454 ED visits for analysis. The median time from first to last visit was 4 years (interquartile range [IQR], 2.1-5.9). The median age was 66 years (IQR, 49-79 years). Home medications included antihypertensives in 81% of visits, and 60% of visits with available electrocardiograms had a PR interval of 160 milliseconds or more. Heart failure history was reported in 23% of visits. The median AF risk score was 8 (IQR, 4-10) corresponding to a 16% 10-year predicted risk.

Conclusions: Nearly 40% of patients diagnosed with new AF had previous ED visits and displayed validated risk factors for incident AF. The ED provides an opportunity to identify and educate these patients as well as refer them for primary prevention interventions.