Reasons for seeking emergency care for geriatric patients with paroxysmal atrial fibrillation, and the effectiveness of pre-hospital treatment

BACKGROUND. One of the most common age-related conditions is atrial fibrillation (AF). The development of AF in geriatric patients leads to the inevitable prescription of additional medications: anticoagulants and means to control rhythm or frequency. This situation often leads to polypharmacy and an increased risk of dangerous adverse events, which is especially unfavorable for patients with frailty and pre-frailty. In addition, despite the treatment of AF according to clinical recommendations, emergency treatment for such patients remains quite frequent.

OBJECTIVE. Analysis of the reasons for seeking emergency care for geriatric patients with AF and evaluation of the effectiveness of measures carried out at the prehospital stage.

MATERIALS AND METHODS. The study, performed in real clinical practice by an on-site emergency team, involved 36 patients with paroxysmal AF. According to the results of screening using the «Age is not a hindrance» questionnaire, patients were divided into 3 groups: 18 patients without frailty-syndrome (FS) (50 %), 9 patients with pre-frailty syndrome (PFS) (25 %), 9 patients with FS (25 %). The reasons for seeking emergency care were identified, the completeness and adherence to previous therapy were assessed, and outcomes were analyzed. Frequency comparisons were performed using the chi-square test.

RESULTS. The geriatric care was previously available to all patients with FS. In patients with PFS and in patients without FS, screening of the FS was performed for the first time. The causes of treatment in 75 % of cases were palpitations and heart failure, in 16.7 % of cases ― arterial hypertension (systolic pressure above 180 mmHg), in 8.3 % of cases ― arterial hypotension, accompanied by weakness and dizziness. The patient groups had no significant differences in the reason for seeking emergency care (p = 0.287). Increased symptoms of heart failure were significantly more often observed in patients with PFS (44.4 %) and patients with FS (88.8 %), and were not detected in patients without FS (p = 0.036). All patients with AF were prescribed standard therapy before seeking emergency treatment, including rhythm control drugs (propafenone or amiodarone) and oral anticoagulants (apixaban, rivaroxaban). Nevertheless, 16.7 % of the patients without FS took acetylsalicylic acid instead of anticoagulants. The incidence of decreased adherence to treatment in patients without FS was 16.7 %, in patients with PFS ― 66.7 %, while in patients with FS ― 11.1 % (p = 0.048). The restoration of sinus rhythm at the prehospital stage was achieved only in patients without FS in 33.3 % of cases, an adequate reduction in heart rate was achieved in 66.7 % patients without FS, in 33.3 % of patients with PFS and in 16.7 % of patients with FS (p = 0.026). In 33.3 % of cases, patients with FS were hospitalized due to the ineffectiveness of pre-hospital treatment, and in 66.6 % of cases due to the detection of symptoms of decompensation of concomitant chronic heart failure. Overall, the hospital admission rate for patients with paroxysmal AF was 33.3 %.

CONCLUSION. The most common reason for geriatric patients with paroxysmal atrial fibrillation seeking emergency care is insufficient rhythm control. Prehospital therapy was effective mainly in patients without frailty-syndrome, when sinus rhythm restoration was achieved in 33.3% of cases. Hospitalization was necessary in 33.3% of cases due to the ineffectiveness of prehospital measures or as a result of decompensation of heart failure, which was observed mainly in patients with frailty-syndrome. Patients with pre-frailty turned out to be the least committed group to treatment. It is possible that some of them may have signs of dementia, which makes it difficult to take medications, and are subject to a more in-depth examination by the geriatric service.