Key result
Vascular disease is linked to ~88% higher odds of ED referral in urgent care AF patients.
Why the study?
AF is common in urgent care centers, but research regarding its treatment and referral to emergency departments in these settings is scant.
What is the rate of emergency department referral and what clinical factors predict referral versus home discharge among adults presenting with atrial fibrillation to an urgent care center network?
Cohort (n=5,873)
Yes
What is the rate of emergency department referral and what clinical factors predict referral versus home discharge among adults presenting with atrial fibrillation to an urgent care center network?
Urgent care centers can safely discharge over a quarter of presenting atrial fibrillation patients—especially those with known AF already on rate/rhythm control and anticoagulation—and initiate anticoagulation in 60.6% of newly diagnosed patients discharged home, helping reduce emergency department burden.
Urgent care AF referral patterns were associated with vascular disease and known AF; extends registry data but leaves open prospective validation of discharge criteria.
Background: Atrial fibrillation (AF) is a common diagnosis in patients presenting to urgent care centers (UCCs), yet there is scant research regarding treatment in these centers. While some of these patients are managed within UCCs, some are referred for further care in an emergency department (ED). Objectives: We aimed to identify the rate of patients referred to an ED and define predictors for this outcome. We analyzed the rates of AF diagnosis and hospital referral over the years. Finally, we described trends in patient anticoagulation (AC) medication use. Methods: This retrospective study included 5873 visits of patients over age 18 visiting the TEREM UCC network with a diagnosis of AF over 11 years. Multivariate analysis was used to identify predictors for ED referral. Results: In a multivariate model, predictors of referral to an ED included vascular disease (OR 1.88 (95% CI 1.43–2.45), p < 0.001), evening or night shifts (OR 1.31 (95% CI 1.11–1.55), p < 0.001; OR 1.68 (95% CI 1.32–2.15), p < 0.001; respectively), previously diagnosed AF (OR 0.31 (95% CI 0.26–0.37), p < 0.001), prior treatment with AC (OR 0.56 (95% CI 0.46–0.67), p < 0.001), beta blockers (OR 0.63 (95% CI 0.52–0.76), p < 0.001), and antiarrhythmic medication (OR 0.58 (95% CI 0.48–0.69), p < 0.001). Visits diagnosed with AF increased over the years (p = 0.030), while referrals to an ED decreased over the years (p = 0.050). The rate of novel oral anticoagulant prescriptions increased over the years. Conclusions: The rate of referral to an ED from a UCC over the years is declining but remains high. Referrals may be predicted using simple clinical variables. This knowledge may help to reduce the burden of hospitalizations.
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Lebovitz et al. (2023) conducted a cohort in Atrial fibrillation (n=5,873). Vascular disease and clinical/treatment predictors (e.g., previously diagnosed AF, prior anticoagulation, arrival shift) vs. Absence of predictor / reference group (e.g., patients discharged home from urgent care) was evaluated on Referral from urgent care center to an emergency department (ED) (OR 1.88, 95% CI 1.43-2.45, p=<0.001). In atrial fibrillation patients at urgent care centers, 72.2% were referred to an ED, predicted by vascular disease (OR 1.88, p<0.001) while prior AF lowered referral odds (OR 0.31, p<0.001).
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