Barrett et al developed a nomogram for predicting the risk for an adverse event within 30 days of a symptomatic patient with atrial fibrillation presenting to an Emergency Department (ED). The authors are from Vanderbilt University in Nashville.
Adverse events included: return to ED with symptoms, unscheduled hospital admission, cardiovascular complication, death
Parameters:
(1) age in years (from 10 to 100 years)
(2) gender
(3) smoker
(4) COPD
(5) control of ventricular rate
(6) dyspnea in the ED
(7) history of heart failure
(8) edema
(9) hypertension
(10) palpitations
(11) use of beta-blockers at home
(12) use of diuretics at home
points for age =
= (1.111 * (age in years) - 11.1
|
Parameter |
Finding |
Points |
|
gender |
male |
0 |
|
|
female |
6 |
|
smoker |
no |
0 |
|
|
yes |
53 |
|
COPD |
no |
0 |
|
|
yes |
5 |
|
ventricular rate under control |
yes |
0 |
|
|
no |
29 |
|
dyspnea |
no |
0 |
|
|
yes |
28 |
|
history of heart failure |
no |
0 |
|
|
yes |
19 |
|
edema |
no |
0 |
|
|
yes |
15 |
|
hypertension |
no |
0 |
|
|
yes |
12 |
|
palpitations |
no |
0 |
|
|
yes |
6 |
|
on beta-blockers at home |
yes |
0 |
|
|
no |
23 |
|
on diuretics at home |
yes |
0 |
|
|
no |
0.25 |
where:
• Diuretic use seems irrelevant.
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: 0 (unlikely if patient is symptomatic)
• maximum score: 296
|
Points |
Probability of Adverse Event within 30 Days |
|
< 18 |
< 5% |
|
18 to 167 |
(0.0012 * ((points)^2)) + (0.01131 * (points)) + 4.48 |
|
167 to 273 |
(-0.000497 * ((points)^2)) + (0.5992 * (points)) - 46.43 |
|
> 273 |
> 80% |
Specialty: Cardiology
ICD-10: ,
