• Mercedes Varona, Blanca Coll-Vinent, Alfonso Martín, José Carbajosa, Juan Sánchez, Juan Tamargo, Manuel Cancio, Susana Sánchez, Carmen Del Arco, José Ríos, Amparo Fernández-Simón, José M Ormaetxe, Coral Suero, and EMERG-AF investigators (Appendix 1).
• Arrhythmia Division, Spanish Society of Emergency Medicine (SEMES), Spain; Emergency Department, Hospital Universitario de Basurto, Spain. Electronic address: mercedes.varonapeinador@osakidetza.eus.
• Am J Emerg Med. 2021 Dec 1; 50: 270-277.

ObjectiveWe 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.MethodsThis 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.ResultsWe 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.ConclusionsComorbidities 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.Copyright © 2021 Elsevier Inc. All rights reserved.

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