Key result
Primary atrial fibrillation or flutter accounted for 21.5% of 935 ED presentations, with nearly two-thirds of these patients admitted despite 93.6% having mild-moderate symptoms.
Why the study?
Emergency physicians have few resources to guide AF/AFL triage, leading to frequent admissions; characterization of these patients was needed to inform protocols preventing unnecessary hospitalizations.
Observational (n=935)
No
Answers are grounded in this paper and cite their sources.
A large proportion of hemodynamically stable patients presenting to the ED with primary AF/AFL and mild-to-moderate symptoms are unnecessarily admitted, highlighting the need for dedicated outpatient triage protocols.
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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Sadaf et al. (2021) conducted an observational in Atrial fibrillation or flutter (n=935). Primary atrial fibrillation or flutter accounted for 21.5% of 935 ED presentations, with nearly two-thirds of these patients admitted despite 93.6% having mild-moderate symptoms.
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