Assessment of severity and prognostic criterias of the patients admitting to the emergency department with symptomatic bradycardia

Assessment of Severity and Prognostic Criterias of the Patients Admitting to the Emergency Department with Symptomatic Bradycardia Şebnem Şakar, Dokuz Eylül University Emergency Department, İzmir, Turkey Introduction Symptomatic bradycardia is a clinical condition that needs to be diagnosed and treated rapidly in the emergency department since may cause morbidity and mortality in the patient. Although there are many studies on the outcome of these patients, we have not found any studies on the characteristics of outcome groups. In this study, we aimed to investigate the severity and prognosis criteria of patients presenting to the emergency department with symptomatic bradycardia. Materials and Method In our study, patients who were admitted to Dokuz Eylül University Emergency Department between 01.01.2017-31.12.2017 and diagnosed as symptomatic bradycardia by emergency department physicians were included in the study. Patients' informations such as age, gender, cause of admission to the emergency department, medications history, comorbidities, cardiac surgery history, vital signs, type of bradycardia in ECGs, Glasgow Coma Scale, treatment that they got after diagnosis; whether they received medical treatment, external or internal pacemaker implantation, hemodialysis, coronary angiography, and final diagnosis in the emergency department; rates of discharge, hospitalization, intensive care hospitalization, referral to another hospital, death, need for permanent pacemaker, survival data on 1st, 7th and 30th days were evaluated by probel HBYS and recorded on data collection form and statistical analysis was performed. Results 154 patients were included in the study. 53.2% of the patients were female and the median age was 76 years. 20.8% of the patients had syncope, 16.2% had shortness of breath, 16.2% had chest pain, 15.6% had dizziness, 13% had feeling of malaise, 12.3% had weakness, 8.4% had near-syncope, 1.3% patients were admitted for acute drug intake. As a cause of symptomatic bradycardia in 22.1% of the patients had block due to primary conduction system disorder, ischemia in 18.2%, acute renal failure-electrolyte disorder in 13.6%, sensitive carotid syndrome in 13.6%, drug effect in 13.6%, drug interaction in 11%, drug overuse in %4.5, pacemaker dysfunction in 2.6% and sick sinus syndrome in 1.9%. 30.5% of the patients were discharged from the emergency department with cure, 11.7% were admitted to the cardiology or nephrology service, 50% were hospitalized or referred to the cardiology intensive care or general intensive care unit. 17.9% of our patients needed a permanent pacemaker. The 30-day mortality rate of our patients was 7.8%. It was shown that male patients were discharged more and female patients were admitted to intensive care unit more. (p <0.001) Absence of deep bradycardia (OR 1.121) and low lactate (OR 0.538) were significant for patients' discharge. It was found that patients with a diagnosis of drug effect and drug interaction were discharged at a higher rate than the emergency department. (OR 26.478, 26.667, respectively) 30-day mortality was found higher in patients presenting with altered mental status (p = 0.049), low Glaskow coma scale (OR 0.632), symptomatic bradycardia due to acute renal failure / electrolyte disorder (OR 8.467), age (p = 0.034), low saturation (p <0.001) and high respiratory rate (p = 0.002), high lactate (p = 0.004) and low HCO3 levels in initial laboratory findings. Having connective tissue disease (p = 0.021), severe bradycardia on admission (p <0.001) and presence of high grade AV block (p <0.001) were significant in terms of need for permanent pacemaker. Results Discharge rates were found to be higher in patients who diagnosed with symptomatic bradycardia due to drug effect or drug interaction. Lactate elevation was significant in terms of hospitalization. Altered mental status, acute renal failure / electrolyte disturbance, low saturation, high respiratory rate, increased lactate, low HCO3 were found to be significant in terms of mortality. Patients with connective tissue disease, patients who presented with relatively low pulse or high grade AV block were found to have a higher need for permanent pacemaker. Key words: Symptomatic bradycardia, emergency department, outcome