Symptoms in Adults with Atrial Fibrillation Seeking Care in Emergency Department
atrial fibrillation AND emergency department
atrial fibrillation treatment seeking
symptomatic atrial fibrillation
symptoms of atrial fibrillation
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PublisherThe University of Arizona.
RightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
AbstractAtrial fibrillation is a common arrhythmia encountered in the emergency department. In the United States, newly diagnosed cases of atrial fibrillation is projected to be 2.6 million cases in 2030 and the annual prevalence of atrial fibrillation is expected to be 12.1 million in 2030 (Colilla et al., 2013). Patients may present to the emergency department for treatment of atrial fibrillation with a variety of symptoms and therefore makes diagnosing atrial fibrillation based on symptomatology challenging for the clinician. The primary goal of this Doctor of Nursing Practice (DNP) project is to describe symptoms of atrial fibrillation in patients that seek medical treatment in the emergency department. Methods: This descriptive study contains secondary analysis of existing data derived from structured interviews that took place at two academic medical centers. This analysis included 74 patients that presented to the emergency department with symptoms suspected of acute coronary syndrome and were later diagnosed with atrial fibrillation. Descriptive statistics were used to synthesize data, while inferential statistics (bivariate tests) were used to compare symptoms between the age groups. Results: The mean age of subjects was 70 + 13 years, ranging 31 to 92 years. The majority of subjects were men (75.7%) and whites (90.5%). The most common symptoms reported by study subjects included chest discomfort (n = 50; 67.6%), followed by generalized weakness (n = 39; 52.7%) and shortness of breath (n = 39; 52.7%), and palpitations/ funny beating of the heart (n = 36; 48.6%) and unusual fatigue/ tiredness (n = 36; 48.6%). Sweating was the only symptom that was statistically significant in the younger adult group than in the older adult age group. Conclusion: The symptoms identified in this DNP project can be used to aid in identifying patients that present to the emergency with symptomatic atrial fibrillation. Further efforts for the assessment of atrial fibrillation should focus on the dissemination of common although nonspecific symptoms to facilitate the inclusion of atrial fibrillation as part of the differential diagnosis.
Degree ProgramGraduate College
Degree GrantorUniversity of Arizona
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Cost-Effectiveness of Apixaban, Dabigatran, Rivaroxaban, and Warfarin for the Prevention of Stroke Prophylaxis in Atrial FibrillationHarrington, Amanda Rose (The University of Arizona., 2012)Objective: The primary objective of this study was to estimate the long-term cost-effectiveness of stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in the United States using new anticoagulant therapies - dabigatran 150 mg, apixaban 5 mg, and rivaroxaban 20 mg - as well as the standard treatment, warfarin. Methods: A Markov decision-analysis model was constructed using data from clinical trials that evaluated the new oral anticoagulants relative to warfarin (apixaban 5 mg & ARISTOTLE, dabigatran 150 mg & RE-LY, and rivaroxaban 20 mg & ROCKET-AF) to compare the lifetime cost and quality-adjusted life expectancy. The Markov model target population was a hypothetical cohort of 70-year old patients with nonvalvular atrial fibrillation, an increased risk for stroke (CHADS₂ ≥ 1, or equivalent), a renal creatinine clearance (CrCl) of 50 or above, and no contraindication to anticoagulant therapy. Using pair-wise comparisons of each therapy, analyses were conducted to evaluate incremental cost-effectiveness ratios (ICERs), net monetary benefits (NMBs), lifetime costs, life-years, and quality-adjusted life-years (QALYs). Results: In the base case, warfarin had the lowest cost of $71,857 (95% confidence interval [CI]: $68,730, $77,452), followed by rivaroxaban 20 mg ($74,023; 95% CI: $70,943, $77,307), dabigatran 150 mg ($78,584; 95% CI: $75,277, $81,968), and apixaban 5 mg ($81,180; 95% CI: $78,642, $83,756). Apixaban 5 mg also yielded the highest QALY estimate, 8.63 (95% CI: 8.52, 8.72), followed by dabigatran 150 mg (8.55; 95% CI: 8.43, 8.67), rivaroxaban 20 mg (8.42; 95% CI: 8.31, 8.54), and warfarin (8.17; 95% CI: 8.1, 8.24). In a Monte Carlo probabilistic sensitivity analysis, apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg, and warfarin were cost effective in 45%, 37%, 19%, 0%, respectively, of the simulations using a willingness-to pay threshold of $50,000 per QALY gained. From the one-way sensitivity analyses, new anticoagulant (apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg) costs and probabilities associated with intracranial hemorrhage and stroke for patients receiving rivaroxaban 20 mg were identified as significant influential variables impacting model results. Conclusion: In patients with NVAF and an increased risk of stroke prophylaxis, apixaban 5 mg, dabigatran 150 mg, and rivaroxaban 20 mg may all be cost-effective alternatives to warfarin depending on pricing in the United States and neurologic events for rivaroxaban 20 mg.
Obstructive and Central Sleep Apnea and the Risk of Incident Atrial Fibrillation in a Community Cohort of Men and WomenTung, Patricia; Levitzky, Yamini S.; Wang, Rui; Weng, Jia; Quan, Stuart F.; Gottlieb, Daniel J.; Rueschman, Michael; Punjabi, Naresh M.; Mehra, Reena; Bertisch, Suzie; Benjamin, Emelia J.; Redline, Susan; Univ Arizona, Arizona Resp Ctr (WILEY, 2017-07-01)Background-Previous studies have documented a high prevalence of atrial fibrillation (AF) in individuals with obstructive sleep apnea (OSA). Central sleep apnea (CSA) has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have distinguished the associations of obstructive sleep apnea from CSA with AF in population studies. Methods and Results-We assessed the association of obstructive sleep apnea and CSA with incident AF among 2912 individuals without a history of AF in the SHHS (Sleep Heart Health Study), a prospective, community-based study of existing ("parent") cohort studies designed to evaluate the cardiovascular consequences of sleep disordered breathing. Incident AF was documented by 12-lead ECG or assessed by the parent cohort. obstructive sleep apnea was defined by the obstructive apnea-hypopnea index (OAHI). CSA was defined by a central apnea index >= 5 or the presence of Cheyne Stokes Respiration. Logistic regression was used to assess the association between sleep disordered breathing and incident AF. Over a mean of 5.3 years of follow-up, 338 cases of incident AF were observed. CSA was a predictor of incident AF in all adjusted models and was associated with 2-to 3-fold increased odds of developing AF (central apnea index >= 5 odds ratio [OR], 3.00, 1.40-6.44; Cheyne-Stokes respiration OR, 1.83, 0.95-3.54; CSA or Cheyne-Stokes respiration OR, 2.00, 1.16-3.44). In contrast, OAHI was not associated with incident AF (OAHI per 5 unit increase OR, 0.97, 0.91-1.03; OAHI 5 to <15 OR, 0.84, 0.59-1.17; OAHI 15 to <30 OR, 0.93, 0.60-1.45; OAHI >= 30 OR, 0.76, 0.42-1.36). Conclusions-In a prospective, community-based cohort, CSA was associated with incident AF, even after adjustment for cardiovascular risk factors.
Incident atrial fibrillation and the risk of fracture in the cardiovascular health studyWallace, E R; Siscovick, D S; Sitlani, C M; Dublin, S; Mitchell, P; Robbins, J A; Fink, H A; Cauley, J A; Bůžková, P; Carbone, L; Chen, Z; Heckbert, S R; Univ Arizona (SPRINGER LONDON LTD, 2017-01-01)In this prospective cohort of 4462 older adults, incident atrial fibrillation (AF) was not statistically significantly associated with subsequent risk of incident fracture. AF is associated with stroke, heart failure, dementia, and death, but its association with fracture is unknown. Therefore, we examined the association of incident AF with the risk of subsequent fracture in the Cardiovascular Health Study (CHS) cohort. Of the CHS participants aged ae<yen>65 years, 4462 were followed between 1991 and 2009, mean follow-up 8.8 years. Incident AF was identified by annual study electrocardiogram (ECG), hospital discharge diagnosis codes, or Medicare claims. Fractures of the hip, distal forearm, humerus, or pelvis were identified using hospital discharge diagnosis codes or Medicare claims. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association between incident AF (time-varying) and the risk of subsequent fracture. We also evaluated whether AF was associated with risk of sustaining a fall. Crude incident fracture rate was 22.9 per 1000 person-years in participants with AF and 17.7 per 1000 person-years in participants without AF. Individuals with incident AF were not at significantly higher risk of hip fracture (adjusted HR = 1.09, 95 % CI 0.83-1.42) or fracture at any selected site (adjusted HR = 0.97, 95 % CI 0.77-1.22) or risk of sustaining a fall (adjusted HR = 1.00, 95 % CI = 0.87-1.16) compared with those without AF. In this cohort of older, community-dwelling adults, incident AF was not shown to be associated with falls or hip or other fractures.