Cardioversion and the Risk of Subsequent Stroke or Systemic Embolism and Death in Emergency Department Patients With Acute Atrial Fibrillation or Flutter
Bibliographic record
Abstract
Objectives Guideline recommendations for the emergency department cardioversion of patients with acute atrial fibrillation/flutter have recently changed. This was related to several studies that found a higher-than-expected risk of subsequent stroke or systemic embolism in cardioverted atrial fibrillation/flutter patients. We sought to confirm an elevated rate of stroke, systemic embolism, or death following emergency department cardioversion to normal sinus rhythm compared with similar patients who were not converted. Methods This retrospective cohort study combined 4 datasets of atrial fibrillation/flutter patients seen at 25 emergency departments in Ontario, Canada, 2000-2012, who were all eligible for cardioversion. We linked patients to province-wide datasets to determine the primary outcome, a composite of stroke, systemic embolism, or all-cause death. To adjust for baseline differences between patients who cardioverted vs those who did not, we used overlap weights based on the propensity score. The latter included 28 variables, including oral anticoagulant prescriptions. Results Of 2521 patients, 2060 (81.7%) converted to sinus rhythm in the emergency department, and 1055 (41.8%) left on anticoagulation. Twelve (0.48%) patients met the primary outcome at 30 days and ≤5 (≤0.2%) at 7 days. In the weighted sample, at 30 days, the primary outcome occurred in 0.37% (95% CI, 0.04%-0.78%) of cardioverted patients vs 0.23% (95% CI, 0.00%-0.60%) in those not cardioverted; the absolute risk increase was 0.13% (95% CI, −0.36% to 0.69%; P = .61), and the number needed to harm was 747. Conclusion In atrial fibrillation/flutter patients eligible for cardioversion at 25 emergency departments, the rate of subsequent stroke or systemic embolism and death was very low. After adjusting for risk factors and post-conversion oral anticoagulant use, the rate of subsequent stroke and systemic embolism and death was not significantly higher in patients who cardioverted vs those who did not.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".