Patients With Atrial Fibrillation and an Alternative Primary Diagnosis in the Emergency Department: A Description of their Characteristics and Outcomes
Notice bibliographique
Résumé
OBJECTIVES: Atrial fibrillation is common in the emergency department (ED). Mortality rates at 30, 90, and 365 days for ED patients with a main diagnosis of atrial fibrillation are 4, 6, and 11%, respectively; there are no data on the characteristics and outcomes of ED patients with atrial fibrillation who have alternative primary ED diagnoses. METHODS: In this single-site, retrospective cohort study, all electrocardiograms (ECGs) with confirmed atrial fibrillation performed in the ED from April 2007 to March 2008 were identified. Repeat ED visits were excluded. ECGs associated with a primary ED diagnosis of atrial fibrillation were excluded, and from the remaining ECGs of patients with a different primary ED diagnosis, half were randomly selected for abstraction. The main outcome measure was all-cause mortality at 30, 90, and 365 days post-ED visit, derived from linkage to a provincewide mortality database. As a secondary analysis, logistic regression was used to compare 90-day mortality of these patients to those with primary ED diagnoses of atrial fibrillation seen during the same time period. RESULTS: Of 768 qualifying index ED visits, 416 charts were abstracted. Mean (± standard deviation [SD]) age was 80.3 (± 11.8) years, and 50.7% were female. Two-thirds had a previous history of atrial fibrillation/flutter, 300 (72.1%) had a CHADS2 score ≥ 2, one died in the ED, and 275 (66.1%) were admitted. The most common primary ED diagnoses were congestive heart failure (12%), pneumonia (6%), and chest pain not yet diagnosed (6%), while most common in-hospital diagnoses were congestive heart failure (15%), chronic obstructive pulmonary disease exacerbation (6%), atrial fibrillation (5%), and pneumonia (5%). Mortalities at 30, 90, and 365 days were 10.6% (95% confidence interval [CI] = 7.8% to 14.0%), 17.4% (95% CI = 13.9% to 21.5%), and 34.2% (95% CI = 29.6% to 39.0%), respectively. In the adjusted analysis, an alternative primary ED diagnosis was associated with an increased risk of death (odds ratio [OR] = 2.75; p = 0.01). CONCLUSIONS: Patients seen in the ED with atrial fibrillation and different primary ED diagnoses are older and have high short- and long-term mortality rates: mortality was three times higher than in patients with primary ED diagnoses of atrial fibrillation. Future studies of atrial fibrillation in the ED should distinguish between these two populations and the potential contribution of atrial fibrillation to mortality in the setting of other primary ED diagnoses.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».