Atrial fibrillation requiring urgent medical care. Approach and outcome in the various departments of admission. Data from the atrial Fibrillation/flutter Italian REgistry (FIRE).

BACKGROUND: The atrial Fibrillation/flutter Italian REgistry (FIRE) study was designed to obtain updated information regarding the clinical characteristics of and medical approach to patients requiring urgent medical care for atrial fibrillation (AF) or atrial flutter in a nationwide and representative series of hospitals.

METHODS: 4570 consecutive patients admitted to the emergency room for AF/atrial flutter were enrolled in 207 hospitals. Of these, 2838 (61.9%) were hospitalized (median 6 days, 43% in cardiology and 57% in internal medicine departments), and constitute the population of this study.

RESULTS: AF/atrial flutter represented 1.5% of all emergency room admissions and 3.3% of all hospitalizations. The mean age was 70 +/- 12 years; 89.9% had AF and 10.1% atrial flutter. In 31% of the hospitalized patients no cardiac disease was present, and in 18% no disease (either cardiac or non-cardiac) could be detected. Predictors of no attempt of cardioversion (37.5% of patients) included: onset of AF > 48 hours, heart failure, increasing age, syncope, admission to a non-cardiology department, stroke or transient ischemic attack (TIA). Predictors of in-hospital mortality (2.2%) included: age, heart failure, diabetes, admission to a non-cardiology department, and stroke or TIA. Predictors of the absence of sinus rhythm at discharge (35.6% of patients) included: no attempt of cardioversion, heart failure, chronic anticoagulation, AF duration > 48 hours, increasing age, stroke or TIA, and admission to a non-cardiology department. Transesophageal echocardiography was performed in only 6% of patients.

CONCLUSIONS: AF/atrial flutter represent a significant burden on the health care system with a higher than expected hospitalization rate from the emergency room. One out of three discharged patients is not in sinus rhythm. There is still a wide gap between evidence-based medicine and real practice in the treatment of patients with AF.