Abstract
ObjectivesClinical familiarity plays a role in health outcomes; the relationship between emergency department (ED) volume and outcomes for atrial fibrillation and flutter (AFF) are not clear. We compared ED presentation outcomes for AFF between high (HV) and low volume (LV) EDs in Alberta, Canada.Methods45,372 AFF presentations for patients aged ≥ 35 years from all 104 EDs in Alberta during 1999 to 2011 using administrative health databases formed a retrospective cohort. EDs were grouped by annual AFF volume: 11 high (>100 presentations) or 93 low (≤100 presentations). Outcomes included hospital admission rate, return to ED for AFF within 30 and 90 days, and death within 30 and 90 days. Analyses included statistical tests and mixed effects modeling.ResultsMean age at ED presentation was 69.8 years (52% male). HV ED presentations were associated with lower admissions (adjusted odds ratio [aOR] = 0.68, 95% confidence interval [CI] 0.64, 0.72; p-value [p]<0.001), ED returns at 90 (aOR = 0.81, 95% CI 0.73, 0.90; p<0.001) days, and a higher likelihood of specialist visits at 30 (aOR = 1.81, 95% CI 1.68, 1.94; p<0.001) and 90 (aOR = 1.82, 95% CI 1.76, 2.03; p<0.001) days. For admitted patients, there were fewer returns to HV EDs at 30 (aOR = 0.37, 95% CI 0.15, 0.87; p = 0.02) and 90 (aOR = 0.48, 95% CI 0.26, 0.89; p = 0.02) days after hospital discharge. There was no difference in death between the two groups.ConclusionsAFF patients presenting to HV EDs experienced fewer admissions and AFF ED revisit and higher specialist referrals compared to LV EDs.
Highlights
Atrial fibrillation and flutter (AFF) are the most common arrhythmias seen in the outpatient setting and affect more than 300,000 adult Canadians.[1]
high volume (HV) emergency department (ED) presentations were associated with lower admissions, ED returns at 90 days, and a higher likelihood of specialist visits at 30 and 90 days
There were fewer returns to HV EDs at 30
Summary
Atrial fibrillation and flutter (AFF) are the most common arrhythmias seen in the outpatient setting and affect more than 300,000 adult Canadians.[1]. Sites with higher volume cases often perform better than sites with less familiarity and lower caseloads.[5,6] In the ED, higher volumes have been associated with lower in-hospital death in multiple conditions (e.g., pneumonia, heart failure, sepsis, stroke, respiratory failure, gastrointestinal haemorrhage, renal failure). [7] These conditions have high associated acute and sub-acute mortality compared to AFF, which is associated with long-term comorbidity (e.g., stroke, heart failure) and longer-term mortality. The relationships between ED volume and outcomes for AFF have not been explored. We compare several outcomes from an ED presentation for AFF, including return ED presentation, follow-up and death (all within 30 and 90 days of ED presentation for AFF), in high and low volume EDs in one large Canadian province
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