New-Onset Atrial Fibrillation Among Patients With Infection in the Emergency Department: A Multicenter Cohort Study of 1-Year Stroke Risk
New-Onset Atrial Fibrillation Among Patients With Infection in the Emergency Department: A Multicenter Cohort Study of 1-Year Stroke Risk
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DOI：
10.1016/j.amjmed.2019.06.048
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发表时间：
2020-03-01
影响因子：
5.9
通讯作者：
Lassen, Annmarie Touborg
中科院分区：
文献类型：
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作者：
Hansen, Tobias Graversgaard;Pottegard, Anton;Lassen, Annmarie Touborg
背景：新发的与感染有关的房颤患者在急诊科是常见的，由于中风的风险增加，可能需要抗血栓治疗。我们的目标是描述有感染、新发的房颤和没有抗血栓治疗的ED患者发生中风的1年风险。方法：这是一项在丹麦和瑞典的4个ED进行的基于人群的队列研究。房颤在到达急诊室时通过心电图来确定，感染通过出院诊断来确定。随访患者病史12个月或直到开始口服抗凝治疗、缺血性中风或死亡。结果：15,505名患者纳入分析，其中48.7%为男性，中位年龄为71岁(IQR，56-83)。在纳入的患者中，2107例(13.6%)有任何类型的心房颤动，其中822例(39.0%)为新发的心房颤动，CHA(2)DS(2)-VASC评分中位数为3(IQR2~4)。感染期间新发的房颤显示，出院后1年发生中风的绝对风险为2.7%(95%可信区间1.6-4.2)，对应的粗危比(HR)为1.4(95%可信区间0.9-2.3)，性别和年龄调整后的心率为1.0(95%可信区间0.6-1.6)，CHA(2)DS(2)-VASc调整后的心率为1.1(95%可信区间，0.7~1.8)。结论：在有感染和新发房颤的ED患者中，未接受口服抗凝治疗的患者发生中风的绝对风险为2.7%。卒中事件主要与性别、年龄和CHA(2)DS(2)-VASC评分确定的危险因素有关。(C)Elsevier Inc.出版的2020年。
BACKGROUND: Patients with new-onset atrial fibrillation in relation to infection are frequent in emergency departments (EDs) and may require antithrombotic therapy because of the increased risk of stroke. Our objective was to describe the 1-year risk of stroke in patients in the ED with infection, new-onset atrial fibrillation, and no antithrombotic therapy.METHODS: This was a population-based cohort study at 4 EDs in Denmark and Sweden. Atrial fibrillation was identified by electrocardiogram (ECG) upon arrival at the ED, and infection was identified by discharge diagnosis. Patient history was followed for 12 months or until initiation of oral anticoagulant therapy, ischemic stroke, or death. Primary outcome was stroke within 12 months compared to patients with infection and no atrial fibrillation.RESULTS: In the analysis, 15,505 patients were included; 48.7% were male and the median age was 71 (IQR, 56-83). Among the included patients, 2107 (13.6%) had atrial fibrillation of any kind and 822 (39.0%) of these had new-onset atrial fibrillation with a median CHA(2)DS(2)-VASc score of 3 (IQR 2-4). New-onset atrial fibrillation during infection showed an absolute postdischarge 1-year risk of stroke of 2.7% (95% CI 1.6-4.2), corresponding to a crude hazard ratio (HR) of 1.4 (95% CI 0.9-2.3), a sex and age adjusted HR of 1.0 (95% CI 0.6-1.6), and a CHA(2)DS(2)-VASc adjusted HR of 1.1 (95% CI, 0.7-1.8) compared to patients with infection but no atrial fibrillation.CONCLUSIONS: Patients in the ED with infection and new-onset atrial fibrillation without current oral anticoagulant therapy had a 2.7% absolute 1-year risk of stroke. Stroke events were mainly related to sex and age and risk factors identified by the CHA(2)DS(2)-VASc score. (C) 2020 Published by Elsevier Inc.