{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T18:42:12Z","timestamp":1764873732084,"version":"3.41.2"},"reference-count":32,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,6,29]],"date-time":"2020-06-29T00:00:00Z","timestamp":1593388800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Limited data are available on the clinical course of patients with history of atrial fibrillation (AF) when admitted in an intensive care environment. We aimed to describe the occurrence of major adverse events in AF patients admitted to a stepdown care unit (SDU) and to analyse clinical factors associated with outcomes, impact of dicumarolic oral anticoagulant (OAC) therapy impact and performance of clinical risk scores in this setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Single\u2010centre, observational retrospective analysis on a population of subjects with AF history admitted to a SDU. Therapeutic failure (composite of transfer to ICU or death) was considered the main study outcome. Occurrence of stroke and major bleeding (MH) was considered as secondary outcomes. The performance of clinical risk scores was evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1430 consecutive patients were enrolled. 194 (13.6%) reported the main outcome. Using multivariate logistic regression, age (odds ratio [OR]: 1.03, 95% confidence interval [CI]: 1.01\u20101.05), acute coronary syndrome (OR:3.10, 95% CI: 1.88\u20105.12), cardiogenic shock (OR:10.06, 95% CI: 5.37\u201018.84), septic shock (OR:5.19,95%CI:3.29\u201018.84), acute respiratory failure (OR:2.49, 95% CI: 1.67\u20103.64) and OAC use (OR: 1.61, 95% CI: 1.02\u20102.55) were independently associated with main outcome. OAC prescription was associated with stroke risk reduction and to both MH and main outcome risk increase. CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>\u2010VASc (c\u2010index: 0.545, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.117 for stroke) and HAS\u2010BLED (c\u2010index:0.503, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.900 for MH) did not significantly predict events occurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In critically ill AF patients admitted to a SDU, adverse outcomes are highly prevalent. OAC use is associated to an increased risk of therapeutic failure, clinical scores seem unhelpful in predicting stroke and MH, suggesting a highly individualized approach in AF management in this setting.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.13317","type":"journal-article","created":{"date-parts":[[2020,6,14]],"date-time":"2020-06-14T11:15:07Z","timestamp":1592133307000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Impact of atrial fibrillation in critically ill patients admitted to a stepdown unit"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3411-2388","authenticated-orcid":false,"given":"Lorenzo","family":"Falsetti","sequence":"first","affiliation":[{"name":"Internal and Sub\u2010intensive Medicine Department A.O.U. \u201cOspedali Riuniti\u201d Ancona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Proietti","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health University of Milan Milan Italy"},{"name":"Liverpool Centre for Cardiovascular Science University of Liverpool Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Zaccone","sequence":"additional","affiliation":[{"name":"Internal and Sub\u2010intensive Medicine Department A.O.U. \u201cOspedali Riuniti\u201d Ancona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Guerra","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health Cardiology and Arrhythmology Clinic Marche Polytechnic University, A.O.U. \u201cOspedali Riuniti\u201d Ancona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cinzia","family":"Nitti","sequence":"additional","affiliation":[{"name":"Internal and Sub\u2010intensive Medicine Department A.O.U. \u201cOspedali Riuniti\u201d Ancona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aldo","family":"Salvi","sequence":"additional","affiliation":[{"name":"Internal and Sub\u2010intensive Medicine Department A.O.U. \u201cOspedali Riuniti\u201d Ancona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanna","family":"Viticchi","sequence":"additional","affiliation":[{"name":"Clinical and Experimental Medicine Department Neurologic Clinic Marche Polytechnic University, A.O.U. \u201cOspedali Riuniti\u201d Ancona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Riccomi","sequence":"additional","affiliation":[{"name":"Emergency Medicine Residency Program Marche Polytechnic University Ancona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattia","family":"Sampaolesi","sequence":"additional","affiliation":[{"name":"Emergency Medicine Residency Program Marche Polytechnic University Ancona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Silvestrini","sequence":"additional","affiliation":[{"name":"Clinical and Experimental Medicine Department Neurologic Clinic Marche Polytechnic University, A.O.U. \u201cOspedali Riuniti\u201d Ancona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluca","family":"Moroncini","sequence":"additional","affiliation":[{"name":"Clinica Medica Azienda Ospedaliero\u2010Universitaria \"Ospedali Riuniti\" di Ancona Ancona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory Y. 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