New-onset atrial fibrillation among patients with infection in the emergency department

A multicentre cohort study of oneyear stroke risk

Tobias Graversgård Hansen, Anton Pottegård, Axel Brandes, Ulf Ekelund, Helene Christine Kildegaard Jensen, Jakob Lundager Forberg, Mikkel Brabrand, Annemarie Touborg Lassen

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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 CHA 2DS 2-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 CHA 2DS 2-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 CHA 2DS 2-VASc score.

OriginalsprogEngelsk
TidsskriftAmerican Journal of Medicine
ISSN0002-9343
DOI
StatusE-pub ahead of print - 9. aug. 2019

Fingeraftryk

Multicenter Studies
Hospital Emergency Service
Cohort Studies
Sex Factors
Age Factors
Denmark
Electrocardiography
Population

Citer dette

Hansen, Tobias Graversgård ; Pottegård, Anton ; Brandes, Axel ; Ekelund, Ulf ; Jensen, Helene Christine Kildegaard ; Forberg, Jakob Lundager ; Brabrand, Mikkel ; Lassen, Annemarie Touborg. / New-onset atrial fibrillation among patients with infection in the emergency department : A multicentre cohort study of oneyear stroke risk. I: American Journal of Medicine. 2019.
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title = "New-onset atrial fibrillation among patients with infection in the emergency department: A multicentre cohort study of oneyear stroke risk",
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 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 CHA 2DS 2-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 CHA 2DS 2-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 CHA 2DS 2-VASc score.",
author = "Hansen, {Tobias Graversg{\aa}rd} and Anton Potteg{\aa}rd and Axel Brandes and Ulf Ekelund and Jensen, {Helene Christine Kildegaard} and Forberg, {Jakob Lundager} and Mikkel Brabrand and Lassen, {Annemarie Touborg}",
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doi = "10.1016/j.amjmed.2019.06.048",
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New-onset atrial fibrillation among patients with infection in the emergency department : A multicentre cohort study of oneyear stroke risk. / Hansen, Tobias Graversgård; Pottegård, Anton; Brandes, Axel; Ekelund, Ulf; Jensen, Helene Christine Kildegaard; Forberg, Jakob Lundager; Brabrand, Mikkel; Lassen, Annemarie Touborg.

I: American Journal of Medicine, 09.08.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - New-onset atrial fibrillation among patients with infection in the emergency department

T2 - A multicentre cohort study of oneyear stroke risk

AU - Hansen, Tobias Graversgård

AU - Pottegård, Anton

AU - Brandes, Axel

AU - Ekelund, Ulf

AU - Jensen, Helene Christine Kildegaard

AU - Forberg, Jakob Lundager

AU - Brabrand, Mikkel

AU - Lassen, Annemarie Touborg

PY - 2019/8/9

Y1 - 2019/8/9

N2 - 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 CHA 2DS 2-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 CHA 2DS 2-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 CHA 2DS 2-VASc score.

AB - 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 CHA 2DS 2-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 CHA 2DS 2-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 CHA 2DS 2-VASc score.

U2 - 10.1016/j.amjmed.2019.06.048

DO - 10.1016/j.amjmed.2019.06.048

M3 - Journal article

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

ER -