Abstract 12515: A Clinical Decision Aid to Identify Emergency Department Patients With Atrial Fibrillation at Low Risk for 30-Day Adverse Events
Introduction: Atrial fibrillation (AF) affects millions of Americans and is associated with $26 billion in healthcare costs, largely driven by frequent hospitalizations. Over 70% of patients hospitalized for AF are initially managed in an emergency department (ED). Such ED visits are increasing and 70% result in admissions.
Hypothesis: Our aim was 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 and thus potentially eligible for safe ED discharge.
Methods: We conducted a prospective observational cohort study at a university-affiliated, tertiary-care, ED in the US. Patients were enrolled from June 9, 2010 to February 28, 2013 and followed for 30 days. We prospectively enrolled a convenience sample of ED patients presenting with signs (e.g., tachycardia, dyspnea) or symptoms (e.g., palpitations, chest pain, shortness of breath, syncope) consistent with symptomatic AF. Candidate predictors were based on data available in the first two hours of the ED evaluation. The decision aid was derived using the following
Methods: model approximation (preconditioning), and strong bootstrap internal validation. We utilized an ordinal outcome hierarchy defined as the incidence of the most severe adverse event within 30 days of the ED evaluation: return ED visit, hospital readmission, decompensated heart failure, stroke, and death.
Results: Of the 497 patients enrolled, stroke and AF-related death occurred in 13 (3%) and 4 (<1%) patients within 30 days of their ED visit, respectively. AFFORD consists of variables that should be available within the first two hours of ED management. The Figure presents the AFFORD predictors and nomogram. The decision aid’s c-statistic was 0.7 (95% CI, 0.65, 0.74).
Conclusions: Among ED patients with AF, AFFORD provides the first decision aid for identifying patients who are at low risk for 30-day adverse events and candidates for safe discharge.
Author Disclosures: T.W. Barrett: Research Grant; Modest; The Clinical and Translational Science Award (CTSA) from the National Center for Research Resources, Grant UL1 RR024975. Research Grant; Significant; NIH grant K23 HL102069 from the National Heart, Lung and Blood Institute. Consultant/Advisory Board; Modest; Boehringer Ingelheim Pharmaceuticals, Red Bull GmbH. A.B. Storrow: Research Grant; Significant; NIH K12HL1090 and UL1TR000445. C.A. Jenkins: None. R.L. Abraham: None. D. Liu: None. K.F. Miller: None. K. Moser: None. S. Russ: None. D.M. Roden: Research Grant; Significant; NIH (U19 HL65962 and HL092217). F.E. Harrell: None. D. Darbar: Research Grant; Significant; NIH (U19 HL65962 and HL092217).
- © 2014 by American Heart Association, Inc.