Emergency Department Re-Presentation for Atrial Fibrillation and Atrial Flutter

Abstract Background Identification and appropriate management of patients with atrial fibrillation (AF) is critical to mitigate the consequences of the disease. We sought to assess the frequency and pattern of the emergency department (ED) use by patients who presented with AF and/or atrial flutter...

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Published in:Canadian journal of cardiology 2016-03, Vol.32 (3), p.344-348
Main Authors: Redfearn, Damian P., MD, Furqan, Muhammad Ali, BSc, Enriquez, Andres, MD, Barber, David, Shaw, Cathy, RCT, Simpson, Christopher, MD, Baranchuk, Adrian, MD, Michael, Kevin, MD, Abdollah, Hoshiar, MB, ChB, Brison, Robert J., MD, MPH
Format: Article
Language:English
Subjects:
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Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - complications
Atrial Fibrillation - drug therapy
Atrial Fibrillation - physiopathology
Atrial Flutter - complications
Atrial Flutter - drug therapy
Atrial Flutter - physiopathology
Canada - epidemiology
Cardiovascular
Electrocardiography
Emergency Service, Hospital
Female
Humans
Incidence
Male
Patient Readmission - trends
Prognosis
Retrospective Studies
Risk Factors
Stroke - epidemiology
Stroke - etiology
Stroke - prevention & control
Survival Rate - trends
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Summary:Abstract Background Identification and appropriate management of patients with atrial fibrillation (AF) is critical to mitigate the consequences of the disease. We sought to assess the frequency and pattern of the emergency department (ED) use by patients who presented with AF and/or atrial flutter (AFL) in a midsized Canadian hospital. Methods We conducted a retrospective cohort analysis of patients who presented to the ED with AF and/or AFL during the calendar years 2010-2012. Patients were identified using the MUSE (General Electric Healthcare, Bucks, United Kingdom) electrocardiogram database and matched with the National Ambulatory Care Reporting System and Discharge Abstract Database up to and including December 31, 2013, a follow-up period of 12 months. The number of presentations and time between visits was assessed. Admissions were identified and lengths of stay and reason for admission were recorded. Results We identified 1361 patients who represented a total of 4783 visits to the ED, a mean of 2.8 ± 2.9 visits per patient with 949 (69.7%) who returned for a subsequent ED visit in the subsequent 12 months. Mean time between base and subsequent visits was 136.8 ± 114.2 days. ED visits generated 1462 admissions (63.0% at repeat ED visits); mean length of stay was 9.7 ± 16.0 days. Stroke or transient ischemic attack accounted for 80 return visits and 8 deaths in 77 patients, 74% of whom with subtherapeutic or no anticoagulation medication. Conclusions Presentation to the ED with AF and/or AFL, either as a primary reason for consultation or as a secondary diagnosis, was associated with a high risk of subsequent re-presentation and hospital admission.
ISSN:0828-282X
1916-7075
DOI:10.1016/j.cjca.2015.08.006