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New-onset atrial fibrillation among patients with infection in the emergency department : A multicentre cohort study of one-year stroke risk

Hansen, Tobias Graversgaard ; MScPharm, Anton Pottegård ; Brandes, Axel ; Ekelund, Ulf LU ; Jensen, Helene Kildegaard ; Forberg, Jakob Lundager LU ; Brabrand, Mikkel and Lassen, Annmarie Touborg (2019) In The American journal of medicine
Abstract

BACKGROUND: Patients with new-onset atrial fibrillation in relation to infection are frequent in emergency departments (ED) and may require antithrombotic therapy due to increased risk of stroke. Our objective was to describe the one-year risk of stroke in ED patients with infection, new-onset atrial fibrillation and no antithrombotic therapy.

METHODS: Population-based cohort study at four EDs in Denmark and Sweden. Atrial fibrillation was identified by ECG upon arrival at the ED and infection was identified by discharge diagnosis. Patient history was followed for 12months or until initiation of oral anticoagulant therapy, ischemic stroke or death. Primary outcome was stroke within 12months compared to patients with infection and... (More)

BACKGROUND: Patients with new-onset atrial fibrillation in relation to infection are frequent in emergency departments (ED) and may require antithrombotic therapy due to increased risk of stroke. Our objective was to describe the one-year risk of stroke in ED patients with infection, new-onset atrial fibrillation and no antithrombotic therapy.

METHODS: Population-based cohort study at four EDs in Denmark and Sweden. Atrial fibrillation was identified by ECG upon arrival at the ED and infection was identified by discharge diagnosis. Patient history was followed for 12months or until initiation of oral anticoagulant therapy, ischemic stroke or death. Primary outcome was stroke within 12months compared to patients with infection and no atrial fibrillation.

RESULTS: 15,505 patients were included in analysis. 48.7% were male and the median age was 71 (IQR, 56-83). Among the included patients, 2107 (13.6%) had atrial fibrillation of any kind and 822 (39.0%) of these had new-onset atrial fibrillation with a median CHA2DS2-VASc score of 3 (IQR 2-4). New-onset atrial fibrillation during infection showed an absolute post-discharge one-year risk of stroke of 2.7% (95% CI 1.6-4.2), corresponding to a crude HR of 1.4 (95% CI 0.9-2.3), a sex and age adjusted HR of 1.0 (95% CI 0.6-1.6) and a CHA2DS2-VASc adjusted HR of 1.1 (95% CI, 0.7-1.8) compared to patients with infection, but no atrial fibrillation.

CONCLUSIONS: ED patients with infection and new-onset atrial fibrillation without current OAC therapy had a 2.7% absolute one-year risk of stroke. Stroke events were mainly related to sex and age and risk factors identified by the CHA2DS2-VASc score.

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author
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publishing date
type
Contribution to journal
publication status
epub
subject
in
The American journal of medicine
publisher
Elsevier
external identifiers
  • pmid:31404521
  • scopus:85078128639
ISSN
0002-9343
DOI
10.1016/j.amjmed.2019.06.048
language
English
LU publication?
no
additional info
Copyright © 2019. Published by Elsevier Inc.
id
6e2684ea-a05e-41e9-b5b2-bd2e39343a22
date added to LUP
2019-08-30 10:36:27
date last changed
2021-03-03 03:03:29
@article{6e2684ea-a05e-41e9-b5b2-bd2e39343a22,
  abstract     = {<p>BACKGROUND: Patients with new-onset atrial fibrillation in relation to infection are frequent in emergency departments (ED) and may require antithrombotic therapy due to increased risk of stroke. Our objective was to describe the one-year risk of stroke in ED patients with infection, new-onset atrial fibrillation and no antithrombotic therapy.</p><p>METHODS: Population-based cohort study at four EDs in Denmark and Sweden. Atrial fibrillation was identified by ECG upon arrival at the ED and infection was identified by discharge diagnosis. Patient history was followed for 12months or until initiation of oral anticoagulant therapy, ischemic stroke or death. Primary outcome was stroke within 12months compared to patients with infection and no atrial fibrillation.</p><p>RESULTS: 15,505 patients were included in analysis. 48.7% were male and the median age was 71 (IQR, 56-83). Among the included patients, 2107 (13.6%) had atrial fibrillation of any kind and 822 (39.0%) of these had new-onset atrial fibrillation with a median CHA2DS2-VASc score of 3 (IQR 2-4). New-onset atrial fibrillation during infection showed an absolute post-discharge one-year risk of stroke of 2.7% (95% CI 1.6-4.2), corresponding to a crude HR of 1.4 (95% CI 0.9-2.3), a sex and age adjusted HR of 1.0 (95% CI 0.6-1.6) and a CHA2DS2-VASc adjusted HR of 1.1 (95% CI, 0.7-1.8) compared to patients with infection, but no atrial fibrillation.</p><p>CONCLUSIONS: ED patients with infection and new-onset atrial fibrillation without current OAC therapy had a 2.7% absolute one-year risk of stroke. Stroke events were mainly related to sex and age and risk factors identified by the CHA2DS2-VASc score.</p>},
  author       = {Hansen, Tobias Graversgaard and MScPharm, Anton Pottegård and Brandes, Axel and Ekelund, Ulf and Jensen, Helene Kildegaard and Forberg, Jakob Lundager and Brabrand, Mikkel and Lassen, Annmarie Touborg},
  issn         = {0002-9343},
  language     = {eng},
  month        = {08},
  publisher    = {Elsevier},
  series       = {The American journal of medicine},
  title        = {New-onset atrial fibrillation among patients with infection in the emergency department : A multicentre cohort study of one-year stroke risk},
  url          = {http://dx.doi.org/10.1016/j.amjmed.2019.06.048},
  doi          = {10.1016/j.amjmed.2019.06.048},
  year         = {2019},
}