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Impact of atrial fibrillation in critically ill patients admitted to a stepdown unit
Author(s) -
Falsetti Lorenzo,
Proietti Marco,
Zaccone Vincenzo,
Guerra Federico,
Nitti Cinzia,
Salvi Aldo,
Viticchi Giovanna,
Riccomi Francesca,
Sampaolesi Mattia,
Silvestrini Mauro,
Moroncini Gianluca,
Lip Gregory Y. H.,
Capucci Alessandro
Publication year - 2020
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.13317
Subject(s) - medicine , atrial fibrillation , intensive care unit , odds ratio , stroke (engine) , septic shock , retrospective cohort study , confidence interval , population , acute coronary syndrome , sepsis , myocardial infarction , mechanical engineering , environmental health , engineering
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. CHA 2 DS 2 ‐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.