There Are Sex Differences in the Demographics and Risk Profiles of Emergency Department (ED) Patients With Atrial Fibrillation and Flutter, but no Apparent Differences in ED Management or Outcomes.
OBJECTIVE
In non-emergency department (ED) settings, women with atrial fibrillation and flutter (AFF) have different presentations, treatments, and outcomes than men: they are older, less likely to be treated with rhythm control strategies or appropriate anticoagulation, and more likely to have strokes. This has not been investigated in ED patients.


METHODS
Records from consecutive ED patients from January 1 to December 31, 2009, with electrocardiogram-proven AFF at two urban hospitals were collected. Review of administrative and clinical data identified patient demographics, clinical characteristics, comorbidities, and ED treatments. The regional ED database was queried to determine 30-day and 1-year follow-up visits, and the provincial vital statistics database was referenced to obtain 30-day and 1-year mortality; all outcomes were stratified by sex. The primary outcome, which reflected overall appropriateness of ED care, was the proportion of patients who were discharged home at their index ED visits, who then had unscheduled 30-day ED revisits. Secondary outcomes included the proportion of eligible patients who underwent acute rhythm control strategies and the proportion of high-risk patients who had previously inadequately anticoagulation strategies corrected by the emergency physician. Additional outcomes included the ED length of stay (LOS) and 30-day and 1-year rates of stroke and death.


RESULTS
A total of 1,112 records were reviewed: 470 women (42.3%) and 642 men. Women were a median 8 years (interquartile range = 3 to 13 years) older than men, had higher rates of cardiovascular comorbidities, and were more likely to present with atypical symptoms such as weakness or dyspnea. On their index ED visits, 50.2% of women and 41.3% of men were admitted. At 30 days, 39 of 234 (16.7%) women and 55 of 377 (14.6%) men who were discharged at their index ED visits had made revisits, for a risk difference of 2.1% (95% confidence interval = -3.9% to 8.5%). There were no apparent sex differences in the use of acute rhythm control or in the appropriateness of anticoagulation decisions. ED LOS was similar between women and men, as were 30-day and 1-year stroke or death rates.


CONCLUSIONS
Female ED AFF patients were older, had more comorbidities, and were more likely to be admitted. However, the overall management and outcomes, including 30-day revisits, appeared to be similar to that of males, indicating that there appeared to be little sex-based discrepancy in ED care and outcomes.
Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
Frank Xavier
FX
Scheuermeyer
Division of Cardiology, Department of Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
Martha
M
Mackay
Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
Jim
J
Christenson
Department of Emergency Medicine, Mount St. Joseph's Hospital and the University of British Columbia, Vancouver, BC, Canada.
Eric
E
Grafstein
Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
Reza
R
Pourvali
Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
Claire
C
Heslop
Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
Jan
J
MacPhee
Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
John
J
Ward
Division of Cardiology, Department of Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
Brett
B
Heilbron
Division of Cardiology, Department of Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
Lorraine
L
McGrath
Division of Cardiology, Department of Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
Karin
K
Humphries
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D001282:Atrial Flutter / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D015897:Comorbidity; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors