Atzema et al developed 2 models for predicting 30-day mortality for an adult presenting to the Emergency Department for atrial fibrillation. One model is more complex compared to a simplified model. The authors are from the Institute for Clinical Evaluation Sciences, the University of Toronto, Sunnybrook Health Sciences Centre and University Health Network in Toronto.
Patient selection: adult with atrial fibrillation who is brought to the Emergency Department
Outcome: 30-day mortality
Parameters:
(1) serum troponin concentration
(2) other acute diagnosis in the ED (other than atrial fibrillation)
(3) COPD or other pulmonary disease
(4) bleeding risk (gastrointestinal bleeding, hemorrhagic stroke, INR > 3 in the ED)
(5) age in years
(6) congestive heart failure
Parameter
Finding
Points
serum troponin
negative
0
positive
2
other acute diagnosis
absent
0
present
1
COPD, pulmonary disease
absent
0
present
1
bleeding risk
absent
0
present
1
age in years
< 65 years
0
65 to 74 years
1
>= 75 years
2
heart failure
absent
0
present
1
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• The higher the score the greater the risk of 30-day mortality.
Total Score
Risk of 30-day Mortality
0
0.5%
1
1%
2
2-3%
3
3-4%
4 to 8
11%
Performance:
• The area under the ROC curve was 0.81.
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