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Canadian Journal of Cardiology

Sex Differences in Outcomes After Discharge from the Emergency Department for Atrial Fibrillation/Flutter

Published:April 25, 2017DOI:https://doi.org/10.1016/j.cjca.2017.02.002

      Abstract

      Background

      Atrial fibrillation and flutter (AFF) are the most common arrhythmias presenting to emergency departments (EDs). We examined sex differences in outcomes for patients with AFF discharged from the ED in Alberta, Canada.

      Methods

      ED presentations for AFF during 1999-2011 that ended in discharge were extracted from administrative databases for all Alberta residents (age ≥ 35 years). Multivariable models determined the effect of sex on the time to ED return for AFF, the first follow-up visit with a physician, the first follow-up visit with a specialist (cardiologist or internal medicine physician), and death.

      Results

      There were 21,062 patients/ED presentations (47.5% women). About 10% returned to the ED for AFF after discharge; the time to return was similar for both sexes (P = 0.39). Time to a first physician visit was shorter (unadjusted hazard ratio [uHR] = 1.10) and time to a specialist follow-up visit was longer (uHR = 0.93) for women than for men. Interactions between sex and age, socioeconomic groups, and comorbidities were identified that changed the effect of sex on time to follow-up. More women died by 30 (1.3% vs 0.9%; P = 0.009) and 90 (2.9% vs 2.4%, P = 0.02) days. The time between ED discharge and death was shorter for women in 1 socioeconomic group (P = 0.008) and for those with peripheral vascular disease (P = 0.02) or diabetes (P = 0.03).

      Conclusions

      We identified sex differences for time to return to the ED, follow-up visit, and death (most importantly, increased mortality rates among women at 30 and 90 days), and time to death remained significant after adjustment for other demographic and health-related variables. Our findings have important potential implications for physicians in the emergency setting.

      Résumé

      Introduction

      La fibrillation et le flutter auriculaires (FFA) sont les arythmies les plus fréquemment observées aux services des urgences (SU). Nous avons examiné les différences entre les sexes quant aux issues des patients atteints de FFA ayant obtenu leur congé du SU en Alberta, au Canada.

      Méthodes

      De 1999 à 2011, les admissions en raison de FFA qui se sont conclues par un congé ont été extraites des banques de données administratives pour tous les résidents de l’Alberta (âgés ≥ 35 ans). Les modèles multivariés ont déterminé l’effet du sexe sur le temps écoulé avant le retour au SU en raison de FFA, avant la première visite de suivi auprès d’un médecin, avant la première visite de suivi auprès d’un spécialiste (cardiologue ou spécialiste en médecine interne) et avant la mort.

      Résultats

      Il y a eu 21 062 patients/admissions au SU (47,5 % de femmes). Environ 10 % des patients sont retournés au SU en raison de FFA après le congé ; le temps écoulé avant le retour était similaire chez les deux sexes (P = 0,39). Le temps écoulé avant la première visite auprès d’un médecin a été plus court (rapport de risque non ajusté [RRna] = 1,10) et le temps écoulé avant la visite de suivi auprès d’un spécialiste a été plus long (RRna = 0,93) chez les femmes que chez les hommes. Il a été établi que les interactions entre le sexe et l’âge, les groupes socioéconomiques et les comorbidités modifiaient l’effet du sexe sur le temps écoulé avant le suivi. Plus de femmes sont mortes dans les 30 (1,3 % vs 0,9 % ; P = 0,009) et dans les 90 (2,9 % vs 2,4 %, P = 0,02) jours. Le temps écoulé entre le congé du SU et la mort a été plus court chez les femmes de l’un (1) des groupes socioéconomiques (P = 0,008) et pour celles atteintes d’une maladie vasculaire périphérique (P = 0,02) ou de diabète (P = 0,03).

      Conclusions

      Nous avons établi les différences entre les sexes en ce qui concerne le temps écoulé avant le retour au SU, avant la visite de suivi et avant la mort (notamment, les taux de mortalité accrus chez les femmes dans les 30 et les 90 jours), et le temps écoulé avant la mort est demeuré significatif après l’ajustement des autres variables démographiques et relatives à la santé. Nos conclusions ont des répercussions potentielles importantes sur les médecins des urgences.
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