title: Emergency Department Management of Atrial Fibrillation and Flutter and Patient Quality of Life at One Month Postvisit.
abstract: OBJECTIVE
  We identify characteristics of patients with atrial fibrillation or flutter associated with favorable assessments of emergency department (ED) effectiveness and 30-day quality of life.
  
  
  METHODS
  As part of a prospective observational study of ED management and short-term outcomes of patients with nonvalvular atrial fibrillation or flutter, we adapted a disease-specific quality-of-life instrument. By telephone, we administered the Atrial Fibrillation Effect on Quality-of-life survey to patients 30 days after an ED visit in which they were treated for newly diagnosed or recent-onset atrial fibrillation or flutter and discharged home. We also asked respondents to rate the effectiveness of ED treatment. Using data prospectively collected in the ED and extracted from electronic health records, we recorded rhythm management (cardioversion attempts and type) and patient and ED treatment characteristics. Using multivariable regression, we examined the association between these characteristics and patient-reported effectiveness of ED treatment ("very effective" or not) and any atrial fibrillation or flutter quality-of-life effect.
  
  
  RESULTS
  Six hundred fifty-two eligible ED patients (response rate 89%) treated between May 2011 and November 2012 completed follow-up. Of these patients, 454 (69.6%) reported that their ED treatment was "very effective" and 113 (17.3%) reported no quality-of-life influence. In multivariable analyses, there was an association between ED electrocardioversion and perceived ED effectiveness (P<.05) but none between treatment strategy and 30-day atrial fibrillation or flutter quality-of-life score. Respondents who were younger, women, and had worse pre-ED self-reported health (P<.05) were more likely to report a quality-of-life effect.
  
  
  CONCLUSIONS
  In this observational study, ED rhythm management strategy was associated with greater perceived effectiveness of the ED visit but not with a difference in 30-day quality-of-life score.
authors.affiliation: Kaiser Permanente San Rafael Medical Center, San Rafael, CA; Kaiser Permanente Division of Research, Oakland, CA. Electronic address: dballard30@gmail.com.
authors.forename: Dustin W
authors.initials: DW
authors.lastname: Ballard
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Reed
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA.
authors.forename: Nimmie
authors.initials: N
authors.lastname: Singh
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA.
authors.forename: Adina S
authors.initials: AS
authors.lastname: Rauchwerger
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA.
authors.forename: Courtnee A
authors.initials: CA
authors.lastname: Hamity
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA.
authors.forename: E Margaret
authors.initials: EM
authors.lastname: Warton
authors.affiliation: Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA.
authors.forename: Uli K
authors.initials: UK
authors.lastname: Chettipally
authors.affiliation: Kaiser Permanente Oakland Medical Center, Oakland, CA.
authors.forename: Dustin G
authors.initials: DG
authors.lastname: Mark
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA; Kaiser Permanente Sacramento Medical Center, Sacramento, CA.
authors.forename: David R
authors.initials: DR
authors.lastname: Vinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D001282:Atrial Flutter / Q000175:diagnosis / Q000628:therapy*; D002140:California / Q000453:epidemiology; D004554:Electric Countershock; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000889:Anti-Arrhythmia Agents