Characteristics of patients presenting to emergency department for primary atrial fibrillation or flutter at an academic medical center
Open accessAbstract
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.
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The approach of using principal diagnosis to identify AF-specific health care encounters has been validated in prior studies and found to be highly accurate.
“This approach has been validated in prior studies and has been found to be highly accurate at identifying health care encounters specific to AF.”
From Wearable Devices, Health Care Use, and Psychological Well-Being in Patients With Atrial Fibrillation (2024) · cites this paper as [24]
The Study population section (page unavailable) describes comparing coded primary-versus-secondary AF/AFL ED diagnoses with clinicians’ chart-review designations to assess accuracy. It does not establish that this approach was validated in prior studies or report that it was highly accurate at identifying AF-specific health care encounters. The Study limitations section (page unavailable) also acknowledges possible misdiagnosis by coding experts. (LLM, conf=0.82)
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References 16 · Cited by 2
- Authors
- Sadaf, M. I., O'Bryan, J., Biese, K., Chen, S., Deyo, Z., Mendys, P., Sears, S. F., Tuttle, H., Walker, T. J., & Gehi, A. K.
- Affiliations
- Yale New Haven Hospital (US)
- University of North Carolina at Chapel Hill (US)
- East Carolina University (US)
- Corresponding author
- Gehi, Anil K.
- Venue
- Indian Heart Journal
- Publisher
- Elsevier BV
- Published
- 2021-09
- Volume
- 73
- Issue
- 5
- Pages
- 588-593
- ISSN
- 0019-4832 (ISSN-L)
- PMC
- PMC8514404
- OpenAlex
- W3193713659
- Cited by
- 2
- References
- 16
- Citations by year
- 2024: 1 · 2023: 1
- FWCI
- 0.34
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Indian Heart Journal (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- The Scholarship East Carolina University's Institutional Repository (East Carolina University) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- University of North Carolina at Chapel Hill
- Biotronik
- St. Jude Medical
- University of North Carolina Wilmington
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- atrial fibrillation, atrial flutter, emergency department, triage, hospitalization, discharge disposition, symptom severity, hemodynamic stability, healthcare resource utilization
- MeSH terms
- Academic Medical Centers, Atrial Fibrillation, Atrial Flutter, Canada, Emergency Service, Hospital, Humans, Retrospective Studies, Risk Factors, Catheter Ablation
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