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Ann Emerg Med. 2017 May;69(5):562-571.e2. doi: 10.1016/j.annemergmed.2016.10.013. Epub 2017 Jan 19.

Outcomes for Emergency Department Patients With Recent-Onset Atrial Fibrillation and Flutter Treated in Canadian Hospitals.

Author information

1
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: istiell@ohri.ca.
2
Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
3
Department of Emergency Medicine and School for Public Health, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada.
4
Department of Emergency Medicine and Kingston General Hospital Research Institute, Queen's University, Kingston, Ontario, Canada.
5
Libin Cardiovascular Institute/University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
6
University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
7
Division of Cardiology, University of Toronto, Toronto, Ontario, Canada.
8
Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
9
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
10
Division of Emergency Medicine, Schwartz/Reisman Emergency Medicine Institute, University of Toronto, Toronto, Ontario, Canada.
11
Department of Medicine, Queen's University, Kingston, Ontario, Canada.
12
University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Abstract

STUDY OBJECTIVE:

Recent-onset atrial fibrillation and flutter are the most common arrhythmias managed in the emergency department (ED). We evaluate the management and 30-day outcomes for recent-onset atrial fibrillation and flutter patients in Canadian EDs, where cardioversion is commonly practiced.

METHODS:

We conducted a prospective cohort study in 6 academic hospital EDs and enrolled patients who had atrial fibrillation and flutter onset within 48 hours. Patients were followed for 30 days by health records review and telephone. Adverse events included death, stroke, acute coronary syndrome, heart failure, subsequent admission, or ED electrocardioversion.

RESULTS:

We enrolled 1,091 patients with mean age 63.9 years, atrial fibrillation 84.7%, atrial flutter 15.3%, hospital admission 9.0%, and converted to sinus rhythm 80.1%. Although 10.5% of recent-onset atrial fibrillation and flutter patients had adverse events within 30 days, there were no related deaths and 1 stroke (0.1%). Adjusted odds ratios for factors associated with adverse event were hours from onset (1.03/hour; 95% confidence interval [CI] 1.01 to 1.05), history of stroke or transient ischemic attack (2.09; 95% CI 1.01 to 4.36), and pulmonary congestion on chest radiograph (7.37; 95% CI 2.40 to 22.64). Patients who left the ED in sinus rhythm were much less likely to experience an adverse event (P<.001).

CONCLUSION:

Although most recent-onset atrial fibrillation and flutter patients were treated aggressively in the ED, there were few 30-day serious outcomes. Physicians underprescribed oral anticoagulants. Potential risk factors for adverse events include longer duration from arrhythmia onset, previous stroke or transient ischemic attack, pulmonary congestion on chest radiograph, and not being in sinus rhythm at discharge. An ED strategy of sinus rhythm restoration and discharge in most patients is effective and safe.

[Indexed for MEDLINE]

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