Impact of atrial fibrillation in critically ill patients admitted to a stepdown unit.

Abstract

BACKGROUND:

Limited data are available on the clinical course of patients with history of atrial fibrillation (AF) when admitted in an intensive care environment. We aimed to describe the occurrence of major adverse events in AF patients admitted to a stepdown care unit (SDU) and to analyse clinical factors associated with outcomes, impact of dicumarolic oral anticoagulant (OAC) therapy impact and performance of clinical risk scores in this setting.

MATERIALS AND METHODS:

Single-centre, observational retrospective analysis on a population of subjects with AF history admitted to a SDU. Therapeutic failure (composite of transfer to ICU or death) was considered the main study outcome. Occurrence of stroke and major bleeding (MH) was considered as secondary outcomes. The performance of clinical risk scores was evaluated.

RESULTS:

A total of 1430 consecutive patients were enrolled. 194 (13.6%) reported the main outcome. Using multivariate logistic regression, age (odds ratio [OR]: 1.03, 95% confidence interval [CI]: 1.01-1.05), acute coronary syndrome (OR:3.10, 95% CI: 1.88-5.12), cardiogenic shock (OR:10.06, 95% CI: 5.37-18.84), septic shock (OR:5.19,95%CI:3.29-18.84), acute respiratory failure (OR:2.49, 95% CI: 1.67-3.64) and OAC use (OR: 1.61, 95% CI: 1.02-2.55) were independently associated with main outcome. OAC prescription was associated with stroke risk reduction and to both MH and main outcome risk increase. CHA2 DS2 -VASc (c-index: 0.545, P = .117 for stroke) and HAS-BLED (c-index:0.503, P = .900 for MH) did not significantly predict events occurrence.

CONCLUSIONS:

In critically ill AF patients admitted to a SDU, adverse outcomes are highly prevalent. OAC use is associated to an increased risk of therapeutic failure, clinical scores seem unhelpful in predicting stroke and MH, suggesting a highly individualized approach in AF management in this setting.

• Authors: Lorenzo Falsetti, Marco Proietti, Vincenzo Zaccone, Federico Guerra, Cinzia Nitti, Aldo Salvi, Giovanna Viticchi, Francesca Riccomi, Mattia Sampaolesi, Mauro Silvestrini, Gianluca Moroncini, Gregory Y H Lip, Alessandro Capucci
• Journal: European journal of clinical investigation (Eur J Clin Invest) Vol. 50 Issue 11 Pg. e13317 (Nov 2020) ISSN: 1365-2362 [Electronic] England
• PMID: 32535903 (Publication Type: Journal Article, Observational Study)
• Copyright: © 2020 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

Chemical References

• Anticoagulants
• Dicumarol

Topics

• Acute Coronary Syndrome (epidemiology, therapy)
• Aged
• Aged, 80 and over
• Anticoagulants (therapeutic use)
• Atrial Fibrillation (complications, drug therapy)
• Comorbidity
• Critical Illness
• Dicumarol (therapeutic use)
• Female
• Hemorrhage (chemically induced, epidemiology)
• Hospital Mortality
• Hospital Units
• Humans
• Intensive Care Units
• Logistic Models
• Male
• Multivariate Analysis
• Patient Transfer (statistics & numerical data)
• Respiratory Insufficiency (epidemiology, therapy)
• Retrospective Studies
• Shock, Cardiogenic (epidemiology, therapy)
• Shock, Septic (epidemiology, therapy)
• Stroke (etiology, prevention & control)