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. 2021 Sep-Oct;73(5):588-593.
doi: 10.1016/j.ihj.2021.08.005. Epub 2021 Aug 24.

Characteristics of patients presenting to emergency department for primary atrial fibrillation or flutter at an academic medical center

Murrium I Sadaf  1 , James O'Bryan  2 , Kevin Biese  3 , Sarah Chen  4 , Zachariah Deyo  5 , Phil Mendys  6 , Samuel F Sears  7 , Heather Tuttle  3 , T Jennifer Walker  4 , Anil K Gehi  8
Affiliations

Characteristics of patients presenting to emergency department for primary atrial fibrillation or flutter at an academic medical center

Murrium I Sadaf et al. Indian Heart J. 2021 Sep-Oct.

Abstract

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.

Keywords: Emergency department; Outpatient follow up; Primary atrial fibrillation; Primary atrial flutter; Secondary atrial fibrillation; Triage protocol.

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Conflict of interest statement

Declaration of competing interest A.G. reports having received lecture fees from Biotronik, Zoll, St. Jude Medical and research funding support from Bristol Myers Squib Foundation. Other authors have no conflict of interest to report.

Figures

Fig. 1
Fig. 1
Breakdown of the Canadian Cardiovascular Society of Atrial Fibrillation Scale (CCS-SAF) and CHA2DS2VASc Score for atrial fibrillation among patients presenting to the emergency department patients with primary atrial fibrillation/flutter (n = 202).
See this image and copyright information in PMC

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