title: Evaluating early repeat emergency department use in patients with atrial fibrillation: a population-based analysis.
abstract: BACKGROUND
  Emergency department (ED) use by patients with atrial fibrillation is high and will accelerate with the aging of the population. In patients with atrial fibrillation who are discharged from the ED, we aimed to describe their subsequent outpatient care, return ED visits, and management strategies associated with early return.
  
  
  METHODS
  We conducted a retrospective cohort analysis of patients 65 years or older with a primary ED diagnosis of atrial fibrillation who were discharged home from an ED in the province of Ontario, Canada, between April 2007 and March 2010. We describe subsequent outpatient care and repeat ED visits within 14 days of the index visit. We assessed factors associated with a repeat visit, overall, as well as by repeat visit outcome (discharged or admitted).
  
  
  RESULTS
  Among 12,772 index ED visits, the mean (SD) age was 77 (7.4) years, and 14-day mortality was 0.7% (95% CI 0.5%-0.8%). Within 14 days, 67.8% had no follow-up care, 19.4% saw solely a family physician, and 12.8% saw a specialist (internist or cardiologist). There were 1,310 (10.3%) repeat ED visits made by 1,146 (9.0%) patients. Management strategies associated with a lower hazard of a repeat visit included follow-up care with a specialist (hazard ratio 0.61; P = .003) and a digoxin prescription (vs a β-blocker; hazard ratio 0.69, P = .001).
  
  
  CONCLUSIONS
  Among older patients with atrial fibrillation discharged from an ED in the province of Ontario, 9% make 1 or more repeat visits within 14 days. Reductions in repeat emergency visits by low-risk patients are associated with timely specialist follow-up care.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. clare.atzema@ices.on.ca
authors.forename: Clare L
authors.initials: CL
authors.lastname: Atzema
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.forename: Noah M
authors.initials: NM
authors.lastname: Ivers
authors.forename: Alice S
authors.initials: AS
authors.lastname: Chong
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends