Assessment of the Framingham risk factors among ED patients with newly diagnosed atrial fibrillation

Abstract

Study Objective Atrial fibrillation (AF) is often first diagnosed in the emergency department (ED) and accounts for nearly 1% of all ED visits. Our objective was to assess the Framingham Heart Study risk score for AF development in ED patients with newly diagnosed AF. Methods We systematically reviewed the electronic medical records of ED patients with newly diagnosed AF between August 2005 and July 2008. We measured the frequency of the Framingham Heart Study predictors and calculated each patient's risk score. Results During the 3-year study period, 914 patients had 1228 ED visits. New AF was diagnosed in 296 (32%) patients. Among these patients, 107 (36%) were female, 127 (43%) had prior ED visits since 2003, 189 (64%) were taking hypertension medications and 170 (57.4%) had previous electrocardiograms with measurable PR intervals. The median PR interval was 166 ms (151 to 180) and 60% of available PR intervals were ≥160 ms. The median (Interquartile range) age, body mass index, and systolic blood pressure were 66 years (53 to 77), 27 (23 to 31), and 134 mm Hg (118 to 151), respectively. Median risk score was 7 (3 to 9) indicating high predicted risk. Heart failure and cardiac murmurs were previously diagnosed in 45 (15%) and 32 (11%) of these patients, respectively. Conclusions The Framingham risk factors for AF are commonly encountered among ED patients with newly diagnosed AF. The ED might provide an opportunity to identify patients at high risk for AF and refer them for primary prevention interventions.

Prevalence of validated risk factors for developing atrial fibrillation—can we identify high-risk ED patients?

“…[6,7] We have previously reported that these risk factors are present in many ED patients with newly diagnosed AF. [8] Nearly all of the Framingham risk factors are routinely identified during an ED visit including patient age, sex, SBP, home antihypertensive treatment and PR interval (if an ECG is performed). BMI and ages of significant cardiac murmur and heart failure diagnosis might be less reliably documented in the ED record.…”

“…Detailed methodology of the original study has been previously reported. [8] Briefly, adult patients with a primary or supporting International Classification of Disease, Ninth Edition ED diagnosis of AF between August 1, 2005 and July 31, 2008 were eligible for inclusion in the original cohort. Inclusion criteria required documented evidence of AF or atrial flutter on an electrocardiographic (ECG) or rhythm strip.…”

“…We evaluated this score in ED patients with newly diagnosed AF and found that these risk factors are commonly present at the time of diagnosis. [8] Many of these factors are regularly assessed in the ED and could be evaluated quickly without interfering with physicians’ time.…”