Abstract
Background
Clinical guidelines emphasize identifying atrial fibrillation (AF) as a strategy to
reduce stroke risk. Cardiac implantable electronic device (CIED) interrogation at
the point of care may facilitate AF detection, increasing opportunities to identify
patients at high risk for stroke.
Objectives
This study sought to quantify AF prevalence and assess stroke risk in patients with
a CIED who presented to the emergency department (ED).
Methods
This noninterventional, retrospective observational study included adult patients
who presented at a single facility ED that incorporated device interrogation as a
routine standard practice for all patients with a CIED. Interrogations were conducted
in 494 unique patients, and relevant demographic/clinical information was captured
from electronic medical records.
Results
AF was detected via CIED interrogation in 54.8% (271/494) of the unique patient population
that presented to the ED. Device interrogation detected the presence of AF in 110
patients without a documented past history or current diagnosis of AF, representing 22.3% (110/494)
of total unique patients. Based on CHA2DS2-VASc (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus,
prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age
65-74 years, Sex category [female]) risk scoring methodology, over three-quarters
of these newly detected AF patients (78.2%, 86/110) were classified in a high stroke
risk category that reflected a > 2.2% annualized risk, and over half (57.3%, 63/110)
presented to the ED for reasons unrelated to cardiac/dysrhythmia problems.
Conclusions
The use of technology-assisted device interrogation of CIEDs at the point of care
has promise in identifying patients with asymptomatic AF. Results suggest consideration
of routine device interrogation of CIEDs in the ED, regardless of reason for admission
or history of AF.
Keywords
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References
- Heart disease and stroke statistics—2016 update: a report from the American Heart Association.Circulation. 2016; 133: e38-e360
- Atrial fibrillation: a major contributor to stroke in the elderly.Arch Intern Med. 1987; 147: 1561-1564
- Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.Stroke. 1991; 22: 983-988
- Stroke and thromboembolism in atrial fibrillation.Circ J. 2012; 76: 2289-2304
- Noninvasive cardiac monitoring for detection of paroxysmal atrial fibrillation or flutter after acute ischemic stroke: a systematic review.Stroke. 2007; 38: 2935-2940
- Subclinical atrial fibrillation and stroke: insights from continuous monitoring by implanted cardiac electronic devices.Europace. 2015; 17: ii40-ii46
- Accuracy of atrial tachyarrhythmia detection in implantable devices with arrhythmia therapies.Pace. 2004; 27: 983-992
- Pacemaker-detected atrial fibrillation in patients with pacemakers: prevalence, predictors, and current use of oral anticoagulation.Can J Cardiol. 2013; 29: 224-228
- Does atrial fibrillation detected by cardiac implantable electronic devices have clinical relevance?.Cardiol Clin. 2014; 32: 271-281
- Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.Chest. 2010; 137: 263-272
- CHA2DS2-VASc score for atrial fibrillation stroke risk. MD+Calc.(Available at:)https://www.mdcalc.com/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk#evidenceDate accessed: May 7, 2019
- A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA (AnTicoagulation and Risk factors In Atrial fibrillation) study.J Am Coll Cardiol. 2011; 58: 395-401
- ASSERT Investigators. Subclinical atrial fibrillation and the risk of stroke.N Engl J Med. 2012; 366: 120-129
- Incidence of newly detected atrial arrhythmias via implantable devices in patients with a history of thromboembolic events.Stroke. 2010; 41: 256-260
- Atrial fibrillation burden: moving beyond atrial fibrillation as a binary entity: a scientific statement from the American Heart Association.Circulation. 2018; 137: e623-e644
- Practices of cardiac implantable electronic device follow-up: results of the European Heart Rhythm Association survey.Europace. 2012; 14: 423-425
- 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.Circulation. 2019; 140: e125-e151
- Early identification and intervention in patients with atrial fibrillation in the emergency department can significantly improve guideline-based anticoagulation and reduce the risk of stroke.Ann Emerg Med. 2017; 70: S119-S120
Article info
Publication history
Published online: September 07, 2019
Accepted:
June 19,
2019
Received in revised form:
June 11,
2019
Received:
October 17,
2017
Footnotes
Disclosures: This study was sponsored by Pfizer, United States. Sharp HealthCare was a paid consultant to Pfizer in connection with the conduct of this study. Kristina L. Greenwood and Divina Fanning are employees of Sharp HealthCare and did not receive any direct financial support for their work on this manuscript. Matthew Pugh, Peter Belott, and Besa Smith were contracted by Sharp HealthCare in connection with conducting this study and with the development of this manuscript.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
