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.
Résumé
Introduction
L’identification et la prise en charge appropriée des patients souffrant de fibrillation
auriculaire (FA) sont essentielles pour atténuer les conséquences de la maladie. Nous
avons cherché à évaluer la fréquence et le schéma d’utilisation du service des urgences
(SU) d’un hôpital canadien de taille moyenne par les patients qui présentaient une
FA ou un flutter auriculaire (FLA), ou les deux.
Méthodes
Nous avons mené une analyse de cohorte rétrospective constituée des patients qui se
sont présentés au SU pour une FA ou un FLA, ou les deux, au cours des années calendaires
de 2010 à 2012. Les patients ont été identifiés à l’aide de la banque de données sur
les électrocardiogrammes MUSE (GE Healthcare, Bucks, Royaume-Uni) et appariés avec
le Système national d’information sur les soins ambulatoires et la Base de données
sur les congés des patients jusqu’au 31 décembre 2013 inclusivement, soit une période
de suivi de 12 mois. Le nombre de consultations et le laps de temps entre les visites
ont été évalués. Les admissions ont été déterminées, puis les durées de séjour et
la raison de l’admission ont été enregistrées.
Résultats
Nous avons identifié 1361 patients qui ont représenté un total de 4783 visites au
SU, soit une moyenne de 2,8 ± 2,9 visites par patient; parmi ces patients, 949 (69,7
%) sont revenus pour une visite subséquente au SU dans les 12 mois suivants. La durée
moyenne entre la visite initiale et les visites subséquentes a été de 136,8 ± 114,2
jours. Les visites au SU ont généré 1462 admissions (63,0 % de visites répétées au
SU); la durée moyenne du séjour a été de 9,7 ± 16,0 jours. L’accident vasculaire cérébrale
ou l’ischémie cérébrale transitoire a représenté 80 visites subséquentes et 8 décès
chez 77 patients, dont 74 % recevaient des médicaments anticoagulants à des doses
inférieures au seuil thérapeutique ou aucun médicament anticoagulant.
Conclusions
La consultation au SU pour une FA ou un FLA, ou les deux, soit comme principale raison
de consultation ou comme diagnostic secondaire, a été associée à un risque élevé de
consultations et d’admissions subséquentes à l’hôpital.
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Article info
Publication history
Published online: August 13, 2015
Accepted:
August 9,
2015
Received:
August 5,
2013
Footnotes
See page 348 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
