Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2020 Apr 16;10(4):e033482.
doi: 10.1136/bmjopen-2019-033482.

Canada-wide mixed methods analysis evaluating the reasons for inappropriate emergency department presentation in patients with a history of atrial fibrillation: the multicentre AF-ED trial

Kathryn Lauren Hong  1   2 , Corinne Babiolakis  3 , Brigita Zile  3 , Milena Bullen  3 , Sohaib Haseeb  3 , Frank Halperin  4 , Corinne M Hohl  5 , Kirk Magee  6 , Roopinder K Sandhu  7 , Simon Yu Tian  1 , Ashley Kennedy  8 , Trudie Lobban  2 , Zana Mariano  2 , Paul Dorian  2 , Paul Angaran  2 , Marilyn Evans  9 , Peter Leong-Sit  9 , Benedict M Glover  10   2
Affiliations
Multicenter Study

Canada-wide mixed methods analysis evaluating the reasons for inappropriate emergency department presentation in patients with a history of atrial fibrillation: the multicentre AF-ED trial

Kathryn Lauren Hong et al. BMJ Open. .

Abstract

Objectives: The primary objective of this study was to ascertain the reasons for emergency department (ED) attendance among patients with a history of atrial fibrillation (AF).

Design: Appropriate ED attendance was defined by the requirement for an electrical or chemical cardioversion and/or an attendance resulting in hospitalisation or administration of intravenous medications for ventricular rate control. Quantitative and qualitative responses were recorded and analysed using descriptive statistics and content analysis, respectively. Random effects logistic regression was performed to estimate the OR of inappropriate ED attendance based on clinically relevant patient characteristics.

Participants: Participants ≥18 years with a documented history of AF were approached in one of eight centres partaking in the study across Canada (Ontario, Nova Scotia, Alberta and British Columbia).

Results: Of the 356 patients enrolled (67±13, 45% female), the majority (271/356, 76%) had inappropriate reasons for presentation and did not require urgent ED treatment. Approximately 50% of patients(172/356, 48%) were driven to the ED due to symptoms, while the remainder presented on the basis of general fear or anxiety (67/356, 19%) or prior medical advice (117/356, 33%). Random effects logistic regression analysis showed that patients with a history of congestive heart failure were significantly more likely to seek urgent care for appropriate reasons (p=0.03). Likewise, symptom-related concerns for ED presentation were significantly less likely to result in inappropriate visitation (p=0.02). When patients were surveyed on alternatives to ED care, the highest proportion of responses among both groups was in favour of specialised rapid assessment outpatient clinics (186/356, 52%). Qualitative content analysis confirmed these results.

Conclusions: Improved education focused on symptom management and alleviating disease-related anxiety as well as the institution of rapid access arrhythmias clinics may reduce the need for unnecessary healthcare utilisation in the ED and subsequent hospitalisation.

Trial registration number: NCT03127085.

Keywords: atrial fibrillation; atrial fibrillation management; cardiology; emergency department.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CONSORT diagram showing participant flow and final cohort. AF, atrial fibrillation; CONSORT, Consolidated Standards of Reporting Trials; ED, emergency department.
Figure 2
Figure 2
Proportion of survey responses of patient-specific reasons for seeking urgent care; **p<0.0001. ED, emergency department.
Figure 3
Figure 3
Select patient quotes. AF, atrial fibrillation; ED, emergency department.
See this image and copyright information in PMC

References

    1. Wilke T, Groth A, Mueller S, et al. . Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Europace 2013;15:486–93. 10.1093/europace/eus333 - DOI - PubMed
    1. Atzema CL, Austin PC, Miller E, et al. . A population-based description of atrial fibrillation in the emergency department, 2002 to 2010. Ann Emerg Med 2013;62:570–7. 10.1016/j.annemergmed.2013.06.005 - DOI - PubMed
    1. Chugh SS, Blackshear JL, Shen WK, et al. . Epidemiology and natural history of atrial fibrillation: clinical implications. J Am Coll Cardiol 2001;37:371–8. 10.1016/S0735-1097(00)01107-4 - DOI - PubMed
    1. Go AS, Hylek EM, Phillips KA, et al. . Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the anticoagulation and risk factors in atrial fibrillation (atria) study. JAMA 2001;285:2370–5. 10.1001/jama.285.18.2370 - DOI - PubMed
    1. Naccarelli GV, Varker H, Lin J, et al. . Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 2009;104:1534–9. 10.1016/j.amjcard.2009.07.022 - DOI - PubMed

Publication types

MeSH terms

Associated data