Abstract 13106: Prevalence, Characteristics, and Outcomes of Atrial Fibrillation Patients Attended by Emergency Medical Services

Abstract

Introduction: Atrial fibrillation (AF) remains the most common sustained cardiac arrythmia and is a growing burden on healthcare resources, despite improvements in prevention and management. AF is a common cause of hospitalisation, and for acute episodes, patients often contact Emergency Medical Services (EMS) for treatment and transport. However, there is a paucity of data describing the burden of AF presentations on EMS. Aims: To determine prevalence, characteristics, and outcomes of patients presenting with AF attended by EMS using a large population-based sample. Methods: Consecutive EMS attendances for AF in Victoria, Australia from January 2015 to June 2019 were included if patients had a diagnosis of ‘AF’ or ‘arrhythmia’ with AF on electrocardiogram. Data were individually linked to emergency, hospital admission, and mortality records. Results: AF was the reason for emergency ambulance attendance in 23,925 of 2,237,145 cases (1.1%). Median (IQR) age was 76 (66,84) years and 57% were female. Eighty-four percent of patients had a high thromboembolic risk (CHA 2 DS 2 -VASc score ≥2), 73% had a heart rate >100bpm, and >50% were normotensive (mean SBP 133 ± 28mmHg). Forty-four percent of patients received no medical intervention by paramedics and 98% were transported to hospital. From the Emergency Department, 19% of patients were discharged home, 36% went to a short-stay unit, 34% were admitted to a general medical ward, and 7% were admitted to a coronary care unit. Median (IQR) length of stay for those admitted was 1 (1,4) day. Of 5,000 cases reattended for AF during the 4.5 year study period, 22% of reattendances occurred within 30 days and 34% within 6 months of the index event. Overall, 22% died during the study period, 37% of those within 6 months of the index event. Conclusions: EMS utilisation for acute episodes of AF is common and associated with many reattendances. Further studies are required to investigate novel pathways of care to reduce AF burden on healthcare systems.