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Cardiac biomarkers predict mortality in emergency patients presenting with atrial fibrillation.

ABSTRACT: OBJECTIVES:To assess the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) serum levels for mid-term mortality in patients presenting with symptomatic atrial fibrillation (AF) to an emergency department. METHODS:Non-interventional cohort/follow-up study, including consecutive patients presenting to a tertiary care university emergency department due to symptomatic AF between 2012 and 2016. Multivariable Cox proportional hazard regression models were used to estimate the mortality rates and hazards per 100 patient-years (pry) for NT-proBNP and hs-TnT serum levels in quintiles. RESULTS:2574 episodes of 1754 patients (age 68 (IQR 58-75) years, female gender 1199 (44%), CHA2DS2-VASc 3 (IQR 1-4)) were recorded. Following the exclusion of incomplete datasets, 1780 episodes were available for analysis. 162 patients deceased during the mid-term follow-up (median 23 (IQR 4-38) months); the mortality rate was 4.72/100 pry. Hazard for death increased with every quintile of NT-proBNP by 1.53 (HR; 95%?CI 1.27 to 1.83; p<0.001) and by 1.31 (HR; 95%?CI 1.10 to 1.55; p=0.002) with every quintile of hs-TnT in multivariate Cox-regression analysis. No interaction between NT-proBNP and hs-TnT levels could be observed. CONCLUSION:Elevated NT-proBNP and hs-TnT levels are independently associated with increased mid-term mortality in patients presenting to an emergency department due to symptomatic AF. TRIAL REGISTRATION NUMBER:NCT03272620; Results.

SUBMITTER: Niederdockl J

PROVIDER: S-EPMC6580776 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Cardiac biomarkers predict mortality in emergency patients presenting with atrial fibrillation.

Niederdöckl Jan J Simon Alexander A Schnaubelt Sebastian S Schuetz Nikola N Laggner Roberta R Sulzgruber Patrick P Spiel Alexander O AO Herkner Harald H Laggner Anton N AN Domanovits Hans H

Heart (British Cardiac Society) 20181110 6

<h4>Objectives</h4>To assess the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) serum levels for mid-term mortality in patients presenting with symptomatic atrial fibrillation (AF) to an emergency department.<h4>Methods</h4>Non-interventional cohort/follow-up study, including consecutive patients presenting to a tertiary care university emergency department due to symptomatic AF between 2012 and 2016. Multivariable Cox proportional ...[more]

PMID: 30415208

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Project description:BackgroundAtrial fibrillation (AF) is a common arrhythmia that causes numerous visits to emergency departments (ED). The aim of the FinFib2 study was to evaluate whether treatment of patients with AF in ED is consistent with the contemporary European Society of Cardiology (ESC) management guidelines. Here we report the results of antiarrhythmic drug therapy (AAD) in ED.MethodsAll patients within the two-week study period whose primary reason for the ED visit was symptomatic AF were included into this prospective multicentre study. Comprehensive data on factors contributing to the treatment of AF were collected, including a data of previous use of ADDs, and changes made for them during a visit in ED.ResultsThe study population consisted of 1013 consecutive patients (mean age 70 ± 13 years, 47.6% female). The mean European Heart Rhythm Association (EHRA) symptom score was 2.2 ± 0.8. Rhythm control strategy was opt for 498 (63.8%) and 140 (64.5%) patients with previously and newly diagnosed AF, respectively. In patients with previously diagnosed AF the most frequently used AAD was a beta blocker (80.9%). Prior use of class I (11.4%) and III (9.1%) AADs as well as start or adjustment of their dosage (7.4%) were uncommon. Most of the patients with newly diagnosed AF were prescribed a beta blocker (71.0%) or a calcium channel antagonist (24.0%), and only two of them received class I or class III AADs.ConclusionsOur data demonstrated that in patients presenting to the ED with recurrent symptomatic AF and aimed for rhythm control strategy, the use of class I and class III AADs was rare despite ESC guideline recommendations. It is possible that early adaptation of a more aggressive rhythm control strategy might improve a quality of life for symptomatic patients and alleviate the ED burden associated with AF. Beta blockers were used by majority of patients as rate control therapy both in rate and rhythm control groups.Trial registrationNCT01990105 . Registered 15 November 2013.

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Cardiac biomarkers predict mortality in emergency patients presenting with atrial fibrillation.

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Cardiac biomarkers predict mortality in emergency patients presenting with atrial fibrillation.

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