Prognostic impact of atrial fibrillation and flutter temporal pattern on anticoagulation and return visits to the emergency department: A historic cohort of 1112 patients

Background: Emergency department (ED) visits due to atrial fibrillation and flutter (AFF) are common, and provide an opportunity to define stroke risk. The prognostic impact of AFF duration on return ED visits is unknown. We aimed to investigate both the prognostic impact of AFF classification on ED visits and the adherence to guideline recommendations on anticoagulation.

Methods: This single-center historic cohort of every patient treated for AFF in our ED during 2012. Follow-up data was obtained on May 2015 (median follow-up of 863 days).

Results: Among 1112 patients (495 Paroxysmal AF - parAF, 475 Persistent AF - persAF, and 142 flutter), those with parAF were less frequently under oral anticoagulation than persAF and flutter patients (15.8%, 39.4%, 40.1%, p < 0.01). Mean CHA2DS2-VASc scores of parAF were lower than persAF (2.2 vs. 3.12, p < 0.01), and did not differ from those with flutter. Return visits to the ED were highest among flutter patients and lowest among parAF (49.3% vs. 37.2%, p < 0.01). Heart failure, hypertension, female gender and atrial flutter were independent risk factors for repeated visits on multivariate regression.

Conclusions: AFF duration provide prognostic information in the ED. ED return visits were common and particularly incident among flutter patients. Furthermore, stroke risk was high and anticoagulation rates were low across all groups. Patients with paroxysmal AF were less commonly anticoagulated even though their mean CHA2DS2-VASc scores were 2.2. These results reveal that guideline adherence is still lacking and should raise awareness to a stricter patient follow-up after ED visits.