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Mariani MV, Pierucci N, Trivigno S, Cipollone P, Piro A, Chimenti C, Della Rocca DG, Miraldi F, Vizza CD, Lavalle C. Probability Score to Predict Spontaneous Conversion to Sinus Rhythm in Patients with Symptomatic Atrial Fibrillation When Less Could Be More? J Clin Med 2024; 13:1470. [PMID: 38592704 PMCID: PMC10934271 DOI: 10.3390/jcm13051470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 04/10/2024] Open
Abstract
Background: The probability of spontaneous conversion (SCV) to sinus rhythm (SR) in patients presenting to the emergency department (ED) with hemodynamically stable, symptomatic atrial fibrillation (AF) is not well known. Objective: To develop and validate a score to determine the probability of SCV to SR in patients presenting to the ED with hemodynamically stable, symptomatic AF. Methods: This retrospective, observational study enrolled consecutive patients admitted with AF to the ED. Variables associated to SCV during a 6 h "wait-and-see" approach were used to develop and validate a score to determine the probability of SCV to SR in AF patients. The study was divided in two phases: (1) score development and (2) validation of the predictive score. Results: Out of 748 eligible patients, 446 patients were included in the derivation cohort, whereas 302 patients were included in the validation cohort. In the derivation cohort, based on multivariable logistic analysis, a probability score weight was developed including: previous SCV (3 points), AF-related symptom duration < 24 h (5 points), age ≥ 65 years (3 points) and female sex (2 points). The score allowed us to divide patients in three groups based on the probability of SCV to SR during the 6 h observation period. The probability prediction model showed an area under the curve (AUC) of 0.707 and 0.701 in the derivation and validation cohorts, respectively. Conclusions: The proposed score allowed us to predict SCV probability with good accuracy and may help physicians in tailoring AF management in an effective and timely manner.
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Affiliation(s)
- Marco Valerio Mariani
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Nicola Pierucci
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Sara Trivigno
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Pietro Cipollone
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | | | - Fabio Miraldi
- Cardio Thoracic-Vascular and Organ Transplantation Surgery Department, Policlinico Umberto I Hospital, 00161 Rome, Italy;
| | - Carmine Dario Vizza
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (S.T.); (P.C.); (A.P.); (C.C.); (C.D.V.); (C.L.)
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Caldarola P, De Iaco F, Pugliese FR, De Luca L, Fabbri A, Riccio C, Scicchitano P, Vanni S, Di Pasquale G, Gulizia MM, Gabrielli D, Oliva F, Colivicchi F. ANMCO-SIMEU consensus document: appropriate management of atrial fibrillation in the emergency department. Eur Heart J Suppl 2023; 25:D255-D277. [PMID: 37213798 PMCID: PMC10194824 DOI: 10.1093/eurheartjsupp/suad110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Atrial fibrillation (AF) accounts for 2% of the total presentations to the emergency department (ED) and represents the most frequent arrhythmic cause for hospitalization. It steadily increases the risk of thromboembolic events and is often associated with several comorbidities that negatively affect patient's quality of life and prognosis. AF has a considerable impact on healthcare resources, making the promotion of an adequate and coordinated management of this arrhythmia necessary in order to avoid clinical complications and to implement the adoption of appropriate technological and pharmacological treatment options. AF management varies across regions and hospitals and there is also heterogeneity in the use of anticoagulation and electric cardioversion, with limited use of direct oral anticoagulants. The ED represents the first access point for early management of patients with AF. The appropriate management of this arrhythmia in the acute setting has a great impact on improving patient's quality of life and outcomes as well as on rationalization of the financial resources related to the clinical course of AF. Therefore, physicians should provide a well-structured clinical and diagnostic pathway for patients with AF who are admitted to the ED. This should be based on a tight and propositional collaboration among several specialists, i.e. the ED physician, cardiologist, internal medicine physician, anesthesiologist. The aim of this ANMCO-SIMEU consensus document is to provide shared recommendations for promoting an integrated, accurate, and up-to-date management of patients with AF admitted to the ED or Cardiology Department, in order to make it homogeneous across the national territory.
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Affiliation(s)
| | - Fabio De Iaco
- Pronto Soccorso e Medicina d'Urgenza, A.O. Martini, Via Luigi Ferdinando Marsigli, 84 - 10141 Torino (TO), Italy
| | - Francesco Rocco Pugliese
- U.O.C. Medicina e Chirurgia d'Accettazione e d'Urgenza, Ospedale Sandro Pertini, Via dei Monti Tiburtini, 385 - 00157 Roma, Italy
| | - Leonardo De Luca
- U.O.C. di Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Cir.ne Gianicolense, 87 - 00152 Rome, Italy
| | - Andrea Fabbri
- Pronto Soccorso e Medicina d'Urgenza-118, Azienda USL della Romagna, Via Carlo Forlanini, 34 - 47121 Forlì, Italy
| | - Carmine Riccio
- U.O.S.D. Follow up del Paziente Post-Acuto, Dipartimento Cardiovascolare, A.O.R.N. Sant'Anna e San Sebastiano, Via Ferdinando Palasciano, 81100 Caserta, Italy
| | - Pietro Scicchitano
- U.O. Cardiologia-UTIC, Ospedale "F. Perinei", SS96 - 70022 Altamura (BA), Italy
| | - Simone Vanni
- S.O.C. Medicina d'Urgenza, Ospedale San Giuseppe, Empoli (FI) e Direttore Area Formazione, Dipartimento di Emergenza e Area Critica, Azienda USL Toscana Centro, Viale Giovanni Boccaccio, 16/20, 50053 Empoli FI, Italy
| | - Giuseppe Di Pasquale
- Direzione Generale Cura della Persona, Salute e Welfare, Regione Emilia-Romagna, Viale Aldo Moro, 21 - 40127 Bologna, Italy
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Piazza Santa Maria di Gesù, 5 - 95124 Catania, Italy
| | - Domenico Gabrielli
- U.O.C. di Cardiologia, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Cir.ne Gianicolense, 87 - 00152 Rome, Italy
- Fondazione per il Tuo cuore - Heart Care Foundation, Via Alfonso la Marmora, 36- 50121 Firenze, Italy
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare "A. De Gasperis", ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3 - 20162 Milano, Italy
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Via Giovanni Martinotti, 20 - 00135 Roma, Italy
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Dai Q, Mehawej J, Saczynski JS, Tran KV, Abu HO, Lessard D, Fillippaios A, Paul T, Hariri E, Wang W, Tisminetzky M, Soni A, Howard-Wilson S, Waring ME, Goldberg RJ, McManus DD. Usefulness of Self-Reported Physical Activity and Clinical Outcomes in Older Patients With Atrial Fibrillation. Am J Cardiol 2022; 181:32-37. [PMID: 35985871 PMCID: PMC10427165 DOI: 10.1016/j.amjcard.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
Current guidelines encourage regular physical activity (PA) to gain cardiovascular health benefit. However, little is known about whether older adults with atrial fibrillation (AF) who engage in the guideline-recommended level of PA are less likely to experience clinically relevant outcomes. We did a retrospective study based on the data from Systemic Assessment of Geriatric Elements in AF (SAGE-AF) prospective cohort study. The study population consisted of older participants with AF (≥65 years) and a congestive heart failure, hypertension, age, diabetes, stroke vascular disease, age 65 to 75 and sex(CHA2DS2-VASc) score ≥2. PA was quantified by self-reported Minnesota Leisure Time PA questionnaire. Competing risk models were used to examine the association between PA level and clinical outcomes over 2 years while controlling for several potentially confounding variables. A total of 1,244 participants (average age 76 years; 51% men; 85% non-Hispanic White) were studied. A total of 50.5% of participants engaged in regular PA. Meeting the recommended level of PA was associated with lower mortality over 2 years (adjusted hazard ratio 0.60, 95% confidence interval 0.38 to 0.95) but was not associated with rates of stroke or major bleeding. In conclusion, older adults with AF who engaged in guideline-recommended PA are more likely to survive in the long term. Healthcare providers should promote and encourage engagement in PA and tailor interventions to address barriers of engagement.
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Affiliation(s)
- Qiying Dai
- Division of Cardiology, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts.
| | - Jordy Mehawej
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jane S Saczynski
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts
| | - Khanh-Van Tran
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Hawa O Abu
- Division of Cardiology, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Andreas Fillippaios
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Tenes Paul
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Essa Hariri
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Weijia Wang
- Department of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Mayra Tisminetzky
- Division of Geriatrics, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Apurv Soni
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sakeina Howard-Wilson
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - David D McManus
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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