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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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.
Atrial Fibrillation in Rural Adults: An Inpatient Evaluation of Clinical Guidelines AdherenceKlug, Melinda Joyce (The University of Arizona., 2015)Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with a higher incidence in older adults (Iwasaki, Nishida, Kato,& Nattel, 2011). There are limited data regarding AF care for adults in rural communities with AF. Purpose: The purpose of this study was to determine whether patients in a rural community hospital received AF care based on American Heart Association (AHA) Get with the Guidelines-Atrial Fibrillation (GWTG-AF) standardized guidelines and whether use of these guidelines was associated with improved thirty day outcomes. Methods: A retrospective medical records review was used. Medical records of patients with AF as primary or secondary diagnoses in inpatient or emergency department admissions were reviewed to determine whether AF guideline care was provided during the hospital stay. AHA GWTG-AF was used to evaluate guideline based care (January, et al., 2014). Results: The results from this study showed that while quality care is provided to rural patients with AF, standardized guideline care is not consistently provided. Preventative care, such as use of angiotensin converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) was only provided for 50% of patients who required it. Evaluation of thromboembolism risk was not consistently provided for AF patients. Use of the congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, age, sex category (CHADS₂/CHA₂DS₂VASc) score was not used in the emergency department or observation units (ED/OBS) and limited use of CHADS₂/CHA₂DS₂VASc score was shown in the inpatient environment, with only 19.5% of patients receiving assessment of thromboembolism risk. Bleeding risk was not documented by clinicians, such as the hypertension, abnormal renal/liver function, stroke bleeding predisposition, labile INR, elderly, drugs/alcohol (HAS-BLED) score. Thromboembolism medications were administered to 156 (78%) of the patients without documentation of these risk factors. Rate control strategies were used more frequently than rhythm control strategies (76% compared to 15%). There were three readmissions for minor bleeding during the pre-selected readmission window, and did not exhibit enough data to generalize whether immediate 30 day outcomes are affected by adherence to guideline care. Conclusions: While some of the GWTG-AF guidelines are followed for AF patients in this rural environment, there are significant areas where adherence to the guidelines is limited. Use of preventative care measures, thromboembolism risk, bleeding risk, and appropriate anticoagulation administration for patients at risk were areas that did not have adequate guideline adherence. Future research is needed to evaluate what barriers may exist to using guideline based care. Such research can also serve as the basis for education programs for clinicians to increase adherence to guideline care. In addition, future research may include a longer readmission period to evaluate for improved outcomes.
Post-Stroke Outcomes in Atrial Fibrillation Patients Treated with Various Oral AnticoagulantsHonkonen, Marcella; Gaerig, Vanesag; Lang, Roxana; Honkonen, Marcella; College of Pharmacy, The University of Arizona (The University of Arizona., 2015)Objectives: Warfarin has historically been the anticoagulant used for the primary prevention of stroke in atrial fibrillation (AF), however three target specific oral anticoagulants, dabigatran, rivaroxaban, and apixaban, have recently been approved for use in this setting. Current literature lacks a comparison of these four drugs in relation to post-stroke outcomes, and this study aims to compare their performance in a natural setting. Methods: This retrospective cohort study identified stroke patients admitted to an academic medical center between January 2013 and December 2014 using the Quintiles, Inc.-American Heart Association Get With The Guidelines-Stroke database; pertinent data was collected from the database and patient electronic medical records. Primary endpoints measured were length of stay, 30-day readmission, and discharge disposition; secondary endpoints included rates of admission to the intensive care unit (ICU) and complications. Results: Of 940 stroke admissions, 53 ischemic stroke patients were identified as receiving an oral anticoagulant for stroke prevention in AF. The warfarin (n=40) and non-warfarin (dabigatran, rivaroxaban, and apixaban; n=13) groups were well matched regarding admission demographics, however patients taking warfarin were more likely to have an elevated INR at hospital admission (P=0.0053) and receive tPA (P=0.047). Patients in the warfarin group were also statistically significantly more likely to receive warfarin on discharge (P=0.004). No endpoints achieved statistical significance. Conclusions: No differences in post-stroke outcomes between warfarin and non-warfarin oral anticoagulants used for stroke prevention in AF were found.