Factors associated with poor prognosis in patients with atrial fibrillation: An emergency department perspective the EMERG-AF study

Am J Emerg Med. 2021 Dec;50:270-277. doi: 10.1016/j.ajem.2021.07.055. Epub 2021 Jul 31.


Objective: We sought to identify the factors associated with a worse prognosis in Emergency Department (ED) patients with atrial fibrillation (AF), crucial information to guide management decisions.

Methods: This is a secondary analysis of a prospective, multicenter, observational cohort of consecutive AF patients attended in 62 EDs in Spain. Clinical variables were collected on enrollment. Follow-up was performed at 30 days and one year. The primary composite outcome was all-cause mortality, major bleeding and/or stroke at one year. Secondary outcomes were each of these components considered separately, plus one-year cardiovascular mortality and the composite outcome at 30 days.

Results: We analyzed 1107 patients. The primary outcome occurred in 209 patients (18.9%), one-year all-cause mortality in 151 (13.6%), major bleeding in 47 (4.2%), and stroke in 31 (2.8%). Disability (HR 2.064, 95% CI 1.478-2.882), previous known AF (HR 1.829, 95% CI 1.096-3.051), long duration of the AF episode (HR 1.849, 95% CI 1.052-3.252) and renal failure (HR 2.073, 95% CI 1.433-2.999) were independently associated with the primary outcome, whereas anticoagulation at discharge was inversely associated (HR 0.576, 95% CI 0.415-0.801). Disability was associated with mortality, cardiovascular mortality, and the composite at 30 days, and renal failure with mortality and major bleeding.

Conclusions: Comorbidities like renal failure, long AF duration and disability were related to adverse outcomes and should be decisive to guide management decisions in ED patients with AF. Anticoagulation had a positive impact on prognosis and should be the mainstay of therapy in AF patients attended in ED.

Keywords: Atrial fibrillation; Clinical factors; Emergency department; Prognosis.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / mortality*
  • Cause of Death
  • Emergency Service, Hospital*
  • Female
  • Hemorrhage / etiology
  • Hemorrhage / mortality
  • Humans
  • Male
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Stroke / etiology
  • Stroke / mortality