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Probability Score to Predict Spontaneous Conversion to Sinus Rhythm in Patients with Symptomatic Atrial Fibrillation
Marco Valerio Mariani1, Nicola Pierucci1, Sara Trivigno1
1Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, "Sapienza" University of Rome, 00161 Rome, Italy.
Insights
A new score predicts spontaneous conversion to sinus rhythm in emergency department atrial fibrillation patients. This tool aids physicians in effective and timely atrial fibrillation management.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Prediction Models
Background:
- Spontaneous conversion to sinus rhythm (SCV) in emergency department (ED) patients with stable, symptomatic atrial fibrillation (AF) is not well understood.
- Predicting SCV is crucial for effective AF management in the ED.
Purpose of the Study:
- To develop and validate a predictive score for SCV to sinus rhythm (SR) in hemodynamically stable, symptomatic AF patients presenting to the ED.
- To assist clinicians in managing AF patients by estimating SCV probability.
Main Methods:
- Retrospective observational study of consecutive AF patients admitted to the ED.
- Development and validation of a predictive score using multivariable logistic analysis over a 6-hour "wait-and-see" period.
- Two phases: score development (n=446) and validation (n=302).
Main Results:
- A predictive score was developed incorporating: prior SCV (3 points), symptom duration < 24 hours (5 points), age ≥ 65 years (3 points), and female sex (2 points).
- The model stratified patients into three groups based on SCV probability within 6 hours.
- The prediction model demonstrated good accuracy with an AUC of 0.707 (derivation) and 0.701 (validation).
Conclusions:
- A validated score accurately predicts the probability of spontaneous conversion to sinus rhythm in ED patients with stable, symptomatic atrial fibrillation.
- This score can aid physicians in optimizing AF management strategies.
- The score facilitates timely and effective treatment decisions for AF patients in the emergency setting.
Abstract:
Background: The probability of spontaneous conversion (SCV) to sinus rhythm (SR) in patients presenting to the emergency department (ED) with hemodynamically stable, symptomatic atrial fibrillation (AF) is not well known. Objective: To develop and validate a score to determine the probability of SCV to SR in patients presenting to the ED with hemodynamically stable, symptomatic AF. Methods: This retrospective, observational study enrolled consecutive patients admitted with AF to the ED. Variables associated to SCV during a 6 h "wait-and-see" approach were used to develop and validate a score to determine the probability of SCV to SR in AF patients. The study was divided in two phases: (1) score development and (2) validation of the predictive score. Results: Out of 748 eligible patients, 446 patients were included in the derivation cohort, whereas 302 patients were included in the validation cohort. In the derivation cohort, based on multivariable logistic analysis, a probability score weight was developed including: previous SCV (3 points), AF-related symptom duration < 24 h (5 points), age ≥ 65 years (3 points) and female sex (2 points). The score allowed us to divide patients in three groups based on the probability of SCV to SR during the 6 h observation period. The probability prediction model showed an area under the curve (AUC) of 0.707 and 0.701 in the derivation and validation cohorts, respectively. Conclusions: The proposed score allowed us to predict SCV probability with good accuracy and may help physicians in tailoring AF management in an effective and timely manner.
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