title: Atrial fibrillation and flutter outcomes and risk determination (AFFORD): design and rationale.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common sustained arrhythmia affecting over 700,000 individuals in Japan and 2.2 million in the USA. The proper management of patients with AF is critical due to the well-documented association with heart failure and stroke. A strategy to better define the emergency department (ED) management, admission decisions, and spectrum of risk from low to high is needed.
  
  
  METHODS
  The atrial fibrillation and flutter outcomes and risk determination investigation is a prospective, observational cohort study to develop a multivariable clinical prediction rule that accurately estimates risk for adverse outcomes in patients presenting to the ED with symptomatic AF. We will enroll 430 patients at 2 sites who present to the ED with symptomatic AF defined as a new or established diagnosis of AF or atrial flutter that require ED evaluation for a complaint thought related to their rhythm disturbance. The study's endpoint is to develop an accurate, objective, internally validated, reliable clinical prediction rule to risk-stratify ED patients presenting with AF exacerbations. The rule will incorporate patient history and examination findings and laboratory studies obtained upon ED presentation, as well as trends over the first 2 h of care. This investigation's primary outcome is the incidence of any AF-related adverse event at 5 days and 30 days. We expect to complete the study by the end of 2014. The study was registered at Clinicaltrials.gov NCT01138644.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. tyler.barrett@vanderbilt.edu
authors.forename: Tyler W
authors.initials: TW
authors.lastname: Barrett
authors.forename: Alan B
authors.initials: AB
authors.lastname: Storrow
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Jenkins
authors.forename: Frank E
authors.initials: FE
authors.lastname: Harrell
authors.forename: Karen F
authors.initials: KF
authors.lastname: Miller
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Moser
authors.forename: Stephan
authors.initials: S
authors.lastname: Russ
authors.forename: Dan M
authors.initials: DM
authors.lastname: Roden
authors.forename: Dawood
authors.initials: D
authors.lastname: Darbar
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000628:therapy; D001282:Atrial Flutter / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome