There Are Sex Differences in the Demographics and Risk Profiles of Emergency Department ( ED ) Patients With Atrial Fibrillation and Flutter, but no Apparent Differences in ED Management or Outcomes
Open accessAbstract
Objectives: In non–emergency department ( ED ) settings, women with atrial fibrillation and flutter ( AFF ) have different presentations, treatments, and outcomes than men: they are older, less likely to be treated with rhythm control strategies or appropriate anticoagulation, and more likely to have strokes. This has not been investigated in ED patients. Methods: Records from consecutive ED patients from January 1 to December 31, 2009, with electrocardiogram‐proven AFF at two urban hospitals were collected. Review of administrative and clinical data identified patient demographics, clinical characteristics, comorbidities, and ED treatments. The regional ED database was queried to determine 30‐day and 1‐year follow‐up visits, and the provincial vital statistics database was referenced to obtain 30‐day and 1‐year mortality; all outcomes were stratified by sex. The primary outcome, which reflected overall appropriateness of ED care, was the proportion of patients who were discharged home at their index ED visits, who then had unscheduled 30‐day ED revisits. Secondary outcomes included the proportion of eligible patients who underwent acute rhythm control strategies and the proportion of high‐risk patients who had previously inadequately anticoagulation strategies corrected by the emergency physician. Additional outcomes included the ED length of stay ( LOS ) and 30‐day and 1‐year rates of stroke and death. Results: A total of 1,112 records were reviewed: 470 women (42.3%) and 642 men. Women were a median 8 years (interquartile range = 3 to 13 years) older than men, had higher rates of cardiovascular comorbidities, and were more likely to present with atypical symptoms such as weakness or dyspnea. On their index ED visits, 50.2% of women and 41.3% of men were admitted. At 30 days, 39 of 234 (16.7%) women and 55 of 377 (14.6%) men who were discharged at their index ED visits had made revisits, for a risk difference of 2.1% (95% confidence interval = –3.9% to 8.5%). There were no apparent sex differences in the use of acute rhythm control or in the appropriateness of anticoagulation decisions. ED LOS was similar between women and men, as were 30‐day and 1‐year stroke or death rates. Conclusions: Female ED AFF patients were older, had more comorbidities, and were more likely to be admitted. However, the overall management and outcomes, including 30‐day revisits, appeared to be similar to that of males, indicating that there appeared to be little sex‐based discrepancy in ED care and outcomes.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Among individuals with AF, women are more likely than men to experience symptoms and to seek care for these symptoms.
“Studies indicate that among individuals with AF, women are more likely than men to experience symptoms,60,11,12 and to seek care for these symptoms.10,11”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [11]
Women with AF have higher prevalence of hypertension and valvular heart disease and lower prevalence of coronary heart disease than men with AF.
“Women with AF have higher prevalence of hypertension and valvular heart disease and lower prevalence of coronary heart disease than men with AF.5,11,34”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [11]
Women are more likely to seek care for symptoms, which might partly be attributable to higher mean heart rates at presentation.
“Women seem to be more likely to seek care for symptoms, which might partly be attributable to higher mean heart rates at presentation.10,11”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [11]
In a study of patients visiting the emergency department, women were more likely to have longer duration of symptoms and to present with atypical symptoms, such as weakness and fatigue.
“In a study of patients visiting the emergency department, women were more likely to have longer duration of symptoms and to present with atypical symptoms, such as weakness and fatigue.11,12”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [11]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Lip, G. Y. H., Nieuwlaat, R., Pisters, R., Lane, D. A., & Crijns, H. J. G. M. (2010) · Chest · doi:10.1378/chest.09-1584 · Cited by 6,879 · see citing works
Gage, B. F., Waterman, A. D., Shannon, W., Boechler, M., Rich, M. W., & Radford, M. J. (2001) · JAMA · doi:10.1001/jama.285.22.2864 · Cited by 4,832 · see citing works
Pisters, R., Lane, D. A., Nieuwlaat, R., de Vos, C. B., Crijns, H. J. G. M., & Lip, G. Y. H. (2010) · CHEST Journal · doi:10.1378/chest.10-0134 · Cited by 4,517 · see citing works
Chart reviews in emergency medicine research: Where are the methods?
Gilbert, E. H., Lowenstein, S. R., Koziol-McLain, J., Barta, D. C., & Steiner, J. (1996) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(96)70264-0 · Cited by 895 · see citing works
The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation
Singer, D. E., Chang, Y., Fang, M. C., Borowsky, L. H., Pomernacki, N. K., Udaltsova, N., & Go, A. S. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-151-5-200909010-00003 · Cited by 655 · see citing works
Spertus, J., Dorian, P., Bubien, R., Lewis, S., Godejohn, D., Reynolds, M. R., Lakkireddy, D. R., Wimmer, A. P., Bhandari, A., & Burk, C. (2011) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.110.958033 · Cited by 485 · see citing works
Dagres, N., Nieuwlaat, R., Vardas, P. E., Andresen, D., Lévy, S., Cobbe, S. M., Kremastinos, D. T., BREITHARDT, G. E., Cokkinos, D. V., & Crijns, H. J. G. M. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.10.047 · Cited by 420 · see citing works
New-Onset Atrial Fibrillation: Sex Differences in Presentation, Treatment, and Outcome
Humphries, K. H., Kerr, C. R., Connolly, S. J., Klein, G., Boone, J. A., Green, M., Sheldon, R., Talajic, M., Dorian, P., & Newman, D. (2001) · Circulation · doi:10.1161/01.cir.103.19.2365 · Cited by 378 · see citing works
Self-citationFuster, V., Rydén, L., Cannom, D. S., Crijns, H. J. G. M., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Heuzey, J. L., Kay, G. N., Lowe, J. E., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.177031 · Cited by 341 · see citing works
Reassessing the Methods of Medical Record Review Studies in Emergency Medicine Research
Worster, A., Bledsoe, R., Cleve, P., et al. (2005) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2004.11.021 · Cited by 339 · see citing works
Return to the Emergency Department among Elders: Patterns And Predictors
McCusker, J., Cardin, S., Bellavance, F., & Belzile, É. (2000) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2000.tb01070.x · Cited by 266 · see citing works
Sex Differences in Stroke Risk Among Older Patients With Recently Diagnosed Atrial Fibrillation
Jackevicius, C. A. (2012) · JAMA · doi:10.1001/jama.2012.3490 · Cited by 241 · see citing works
Gender-Related Differences in Rhythm Control Treatment in Persistent Atrial Fibrillation
Rienstra, M., van Veldhuisen, D. J., Hagens, V. E., Ranchor, A. V., Veeger, N. J. G. M., Crijns, H. J. G. M., & Gelder, I. C. V. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.05.078 · Cited by 231 · see citing works
Role of gender and personality on quality-of-life impairment in intermittent atrial fibrillation
Paquette, M., Roy, D., Talajic, M. R., Newman, D. R., Couturier, A., Yang, C., & Dorian, P. (2000) · The American Journal of Cardiology · doi:10.1016/s0002-9149(00)01077-8 · Cited by 177 · see citing works
Washam, J. B., Stevens, S. R., Lokhnygina, Y. V., Halperin, J. L., BREITHARDT, G. E., Singer, D. E., Mahaffey, K. W., Hankey, G. J., Berkowitz, S. D., Nessel, C. C., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(14)61836-5 · Cited by 145 · see citing works
A Population-Based Description of Atrial Fibrillation in the Emergency Department, 2002 to 2010
Atzema, C. L., Austin, P. C., Miller, E., Chong, A. S., Yun, L., & Dorian, P. (2013) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2013.06.005 · Cited by 95 · see citing works
Canadian Emergency Department Information System (CEDIS) Presenting Complaint List (Version 1.0)
Grafstein, E., Unger, B., Bullard, M. J., et al. (2003) · Canadian Journal of Emergency Medicine · doi:10.1017/s1481803500008071 · Cited by 80 · see citing works
Self-citationScheuermeyer, F. X., Innes, G. D., Pourvali, R., DeWitt, C., Grafstein, E., Heslop, C., MacPhee, J., Ward, J., Heilbron, B. G., McGrath, L., et al. (2013) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2013.04.004 · Cited by 52 · see citing works
Self-citationScheuermeyer, F. X., Pourvali, R., Rowe, B. H., Grafstein, E., Heslop, C., MacPhee, J., McGrath, L., Ward, J., Heilbron, B. G., & Christenson, J. M. (2014) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2014.09.012 · Cited by 44 · see citing works
Self-citationScheuermeyer, F. X., Grafstein, E., Stenstrom, R., Innes, G. D., Heslop, C., MacPhee, J., Pourvali, R., Heilbron, B. G., McGrath, L., & Christenson, J. M. (2012) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2012.05.007 · Cited by 41 · see citing works
Self-citationBarrett, T. W., & Marill, K. A. (2013) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2013.05.027 · Cited by 25 · see citing works
McGregor, A. J., Peacock, W. F., Chang, A. M., Safdar, B., & Diercks, D. B. (2014) · Academic Emergency Medicine · doi:10.1111/acem.12526 · Cited by 13 · see citing works
Heilbron, B. G., Klein, G. J., Talajic, M. R., & Guerra, P. G. (2005) · PubMed · Cited by 6 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- Connolly S, Gillis A. A 2004 CCS consensus confer- ences on atrial fibrillation. Therapies for the preven- tion of stroke and other vascular events in atrial fibrillation and flutter. Can J Cardiol 2005;21:71B- 3B.
Cited by
Sorted by citations
Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis
Ko, D., Rahman, F., Schnabel, R. B., Yin, X., Benjamin, E. J., & Christophersen, I. E. (2016) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2016.45 · Cited by 353 · see citing works
- Authors
- Scheuermeyer, F. X., Mackay, M., Christenson, J., Grafstein, E., Pourvali, R., Heslop, C., MacPhee, J., Ward, J., Heilbron, B., McGrath, L., & Humphries, K.
- Affiliations
- University of British Columbia (CA)
- Corresponding author
- Scheuermeyer, Frank Xavier
- ORCID
- Venue
- Academic Emergency Medicine
- Publisher
- Wiley
- Published
- 2015-08-20
- Volume
- 22
- Issue
- 9
- Pages
- 1067-1075
- ISSN
- 1069-6563 (ISSN-L)
- 1553-2712
- OpenAlex
- W2157193283
- Cited by
- 48
- References
- 23
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 9 · 2022: 5 · 2021: 2 · 2020: 4 · 2019: 2 · 2018: 4 · 2017: 8 · 2016: 1
- FWCI
- 3.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Academic Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- atrial fibrillation, atrial flutter, sex differences, emergency department care, emergency department revisits, anticoagulation, stroke, mortality, length of hospital stay, cardiovascular comorbidity, atypical presentation, appropriateness of care, women's health disparities, hospitalization, follow-up outcomes, 30-day mortality, one-year mortality, 30-day stroke
- MeSH terms
- Aged, Aged, 80 and over, Atrial Fibrillation, Atrial Flutter, Electrocardiography, Emergency Service, Hospital, Female, Hospitals, Urban, Humans, Length of Stay, Male, Middle Aged, Patient Discharge, Patient Readmission, Retrospective Studies, Risk Factors, Sex Factors, Socioeconomic Factors, Comorbidity
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
