https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland
Background: New onset atrial fibrillation (NOAF) is a common reason for presentation to the emergency room or a Chest Pain Unit (CPU). While current guidelines for atrial fibrillation (AF) management have emphasized integrated long term care there has been less focus on the acute management of new onset AF. Current evidence suggests that patients with a recent diagnosis of AF benefit from intensified care and rhythm control. Further research is required to evaluate the needs of NOAF patients in the CPU.
Purpose: The purpose if this project is to characterize NOAF patients and their treatment pathways in the CPU.
Methods: The data for this study was derived from the HERA-FIB cohort. HERA-FIB is a long term, monocentric, retrospective cohort of 10.222 patients presenting to the CPU of Heidelberg University Hospital between June 2009 and March 2020. The most important inclusion criterion was a documented diagnosis of AF during the CPU stay. Structured follow up was performed according to a step down approach. Patient care remained uninterrupted. The declaration of Helsinki was honored in this project, ethics approval was granted by the local ethics committee. The study was registered at ClinicalTrials.gov (Identifier: NCT05995561).
Results: More than a quarter (27%) of patients in the HERA-FIB cohort had a new onset atrial fibrillation. Overall these patients showed a favorable risk profile regarding age and comorbidities (i.e. hypertension, diabetes mellitus, history of coronary artery disease (CAD), prior stroke) compared to patients with preexisting AF (PRAF). AF related symptoms were the main reason for presentation in 66.4% of NOAF patients compared to only 26.0% of PRAF patients (p<0.0001). Urgent rhythm control by cardioversion was performed more often in NOAF patients than in PRAF patients (24.6% vs. 11.7%, p<0.0001). Average time spent in the CPU of NOAF patients was 279min (IQR 180-444min). The overall discharge rate of NOAF patients was high compared to PRAF patients (44.6% vs. 36.1%, p<0.0001). During the observational period there was a swift uptake of NOAC prescription particularly for NOAF patients, thus lowering the rate of NOAF patients without anticoagulation at discharge.
Conclusions: NOAF patients are common in the CPU and require a thorough, time consuming work up even in a busy CPU. Clinical characteristics and treatment pathways of NOAF patients differ from those of PRAF patients, particularly regarding rhythm control strategies. The introduction of NOACs had a profound impact on the prescription of anticoagulation treatment for NOAF patients.