دورية أكاديمية
أعرض في EDS

The AFFORD clinical decision aid to identify emergency department patients with atrial fibrillation at low risk for 30-day adverse events.

التفاصيل البيبلوغرافية
العنوان: The AFFORD clinical decision aid to identify emergency department patients with atrial fibrillation at low risk for 30-day adverse events.
المؤلفون: Barrett TW; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: tyler.barrett@vanderbilt.edu., Storrow AB; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Jenkins CA; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee., Abraham RL; Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Liu D; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee., Miller KF; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Moser KM; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Russ S; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Roden DM; Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Clinical Pharmacology, Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee., Harrell FE Jr; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee., Darbar D; Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Clinical Pharmacology, Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee.
المصدر: The American journal of cardiology [Am J Cardiol] 2015 Mar 15; Vol. 115 (6), pp. 763-70. Date of Electronic Publication: 2015 Jan 06.
نوع المنشور: Clinical Trial; Journal Article; Observational Study; Research Support, N.I.H., Extramural; Validation Study
اللغة: English
بيانات الدورية: Publisher: Excerpta Medica Country of Publication: United States NLM ID: 0207277 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1913 (Electronic) Linking ISSN: 00029149 NLM ISO Abbreviation: Am J Cardiol Subsets: MEDLINE
أسماء مطبوعة: Original Publication: New York, NY : Excerpta Medica
مواضيع طبية MeSH: Decision Support Techniques* , Emergency Service, Hospital*, Atrial Fibrillation/*complications , Atrial Fibrillation/*therapy , Stroke/*diagnosis , Stroke/*etiology, Aged ; Algorithms ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/mortality ; Female ; Follow-Up Studies ; Hospitals, University ; Humans ; Male ; Middle Aged ; Prospective Studies ; Reproducibility of Results ; Risk Assessment ; Risk Factors ; Stroke/mortality ; Stroke/therapy ; Time Factors ; Treatment Outcome ; United States
مستخلص: There is wide variation in the management of patients with atrial fibrillation (AF) in the emergency department (ED). We aimed to derive and internally validate the first prospective, ED-based clinical decision aid to identify patients with AF at low risk for 30-day adverse events. We performed a prospective cohort study at a university-affiliated tertiary-care ED. Patients were enrolled from June 9, 2010, to February 28, 2013, and followed for 30 days. We enrolled a convenience sample of patients in ED presenting with symptomatic AF. Candidate predictors were based on ED data available in the first 2 hours. The decision aid was derived using model approximation (preconditioning) followed by strong bootstrap internal validation. We used an ordinal outcome hierarchy defined as the incidence of the most severe adverse event within 30 days of the ED evaluation. Of 497 patients enrolled, stroke and AF-related death occurred in 13 (3%) and 4 (<1%) patients, respectively. The decision aid included the following: age, triage vitals (systolic blood pressure, temperature, respiratory rate, oxygen saturation, supplemental oxygen requirement), medical history (heart failure, home sotalol use, previous percutaneous coronary intervention, electrical cardioversion, cardiac ablation, frequency of AF symptoms), and ED data (2 hours heart rate, chest radiograph results, hemoglobin, creatinine, and brain natriuretic peptide). The decision aid's c-statistic in predicting any 30-day adverse event was 0.7 (95% confidence interval 0.65, 0.76). In conclusion, in patients with AF in the ED, Atrial Fibrillation and Flutter Outcome Risk Determination provides the first evidence-based decision aid for identifying patients who are at low risk for 30-day adverse events and candidates for safe discharge.
(Copyright © 2015 Elsevier Inc. All rights reserved.)
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معلومات مُعتمدة: UL1 TR000445 United States TR NCATS NIH HHS; UL1TR000445 United States TR NCATS NIH HHS; U19 HL65962 United States HL NHLBI NIH HHS; R01 HL092217 United States HL NHLBI NIH HHS; U19 HL065962 United States HL NHLBI NIH HHS; HL092217 United States HL NHLBI NIH HHS; K12HL1090 United States HL NHLBI NIH HHS; K12 HL109019 United States HL NHLBI NIH HHS; UL1 RR024975 United States RR NCRR NIH HHS; K23 HL102069 United States HL NHLBI NIH HHS
سلسلة جزيئية: ClinicalTrials.gov NCT01138644
تواريخ الأحداث: Date Created: 20150131 Date Completed: 20150515 Latest Revision: 20240610
رمز التحديث: 20240610
مُعرف محوري في PubMed: PMC4346475
DOI: 10.1016/j.amjcard.2014.12.036
PMID: 25633190
قاعدة البيانات: MEDLINE
الوصف
تدمد:1879-1913
DOI:10.1016/j.amjcard.2014.12.036