Characteristics of patients presenting to emergency department for primary atrial fibrillation or flutter at an academic medical center

Murrium I Sadaf; James O'Bryan; Kevin Biese; Sarah Chen; Zachariah Deyo; Phil Mendys; Samuel F Sears; Heather Tuttle; T Jennifer Walker; Anil K Gehi

doi:10.1016/j.ihj.2021.08.005

Characteristics of patients presenting to emergency department for primary atrial fibrillation or flutter at an academic medical center

Indian Heart J. 2021 Sep-Oct;73(5):588-593. doi: 10.1016/j.ihj.2021.08.005. Epub 2021 Aug 24.

Authors

Affiliations

¹ Department of Internal Medicine, Yale-New Haven Medical Center, New Haven, CT, USA.
² Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
³ Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC, USA.
⁴ Division of Cardiology, Department of Internal Medicine, Chapel Hill, NC, USA.
⁵ Department of Pharmacy, UNC Medical Center, Chapel Hill, NC, USA.
⁶ Department of Pharmacy, UNC Medical Center, Chapel Hill, NC, USA; North American Medical Affairs, Pfizer, NY UNC, USA.
⁷ Departments of Psychology, Cardiovascular Sciences, and Public Health, East Carolina University, Greenville, NC, USA.
⁸ Division of Cardiology, Department of Internal Medicine, Chapel Hill, NC, USA. Electronic address: [email protected].

Abstract

Objective: In the United States, atrial fibrillation (AF) accounts for over 400,000 hospitalizations annually. Emergency Department (ED) physicians have few resources available to guide AF/AFL (atrial flutter) patient triage, and the majority of these patients are subsequently admitted. Our aim is to describe the characteristics and disposition of AF/AFL patients presenting to the University of North Carolina (UNC) ED with the goal of developing a protocol to prevent unnecessary hospitalizations.

Methods: We performed a retrospective electronic medical chart review of AF/AFL patients presenting to the UNC ED over a 15-month period from January 2015 to March 2016. Demographic and ED visit variables were collected. Additionally, patients were designated as either having primary or secondary AF/AFL where primary AF/AFL patients were those in whom AF/AFL was the primary reason for ED presentation. These primary AF/AFL patients were categorized by AF symptom severity score according to the Canadian Cardiovascular Society Severity of Atrial Fibrillation (CCS-SAF) Scale.

Results: A total of 935 patients presented to the ED during the study period with 202 (21.5%) having primary AF/AFL. Of the primary AF/AFL patients, 189 (93.6%) had mild-moderate symptom severity (CCS-SAF ≤ 3). The majority of primary AF/AFL patients were hemodynamically stable, with a mean (SD) SBP of 123.8 (21.3), DBP of 76.6 (14.1), and ventricular rate of 93 (21.9). Patients with secondary AF/AFL were older 76 (13.1), p < 0.001 with a longer mean length of stay 6.1 (7.7), p = 0.31. Despite their mild-moderate symptom severity and hemodynamic stability, nearly 2/3 of primary AF/AFL patients were admitted.

Conclusion: Developing a protocol to triage and discharge hemodynamically stable AF/AFL patients without severe AF/AFL symptoms to a dedicated AF/AFL clinic may help to conserve healthcare resources and potentially deliver more effective care.

Keywords: Emergency department; Outpatient follow up; Primary atrial fibrillation; Primary atrial flutter; Secondary atrial fibrillation; Triage protocol.

MeSH terms

Academic Medical Centers
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / epidemiology
Atrial Fibrillation* / therapy
Atrial Flutter* / diagnosis
Atrial Flutter* / epidemiology
Atrial Flutter* / therapy
Canada
Catheter Ablation*
Emergency Service, Hospital
Humans
Retrospective Studies
Risk Factors