title: Emergency Department Re-Presentation for Atrial Fibrillation and Atrial Flutter.
abstract: BACKGROUND
  Identification and appropriate management of patients with atrial fibrillation (AF) is critical to mitigate the consequences of the disease. We sought to assess the frequency and pattern of the emergency department (ED) use by patients who presented with AF and/or atrial flutter (AFL) in a midsized Canadian hospital.
  
  
  METHODS
  We conducted a retrospective cohort analysis of patients who presented to the ED with AF and/or AFL during the calendar years 2010-2012. Patients were identified using the MUSE (General Electric Healthcare, Bucks, United Kingdom) electrocardiogram database and matched with the National Ambulatory Care Reporting System and Discharge Abstract Database up to and including December 31, 2013, a follow-up period of 12 months. The number of presentations and time between visits was assessed. Admissions were identified and lengths of stay and reason for admission were recorded.
  
  
  RESULTS
  We identified 1361 patients who represented a total of 4783 visits to the ED, a mean of 2.8 ± 2.9 visits per patient with 949 (69.7%) who returned for a subsequent ED visit in the subsequent 12 months. Mean time between base and subsequent visits was 136.8 ± 114.2 days. ED visits generated 1462 admissions (63.0% at repeat ED visits); mean length of stay was 9.7 ± 16.0 days. Stroke or transient ischemic attack accounted for 80 return visits and 8 deaths in 77 patients, 74% of whom with subtherapeutic or no anticoagulation medication.
  
  
  CONCLUSIONS
  Presentation to the ED with AF and/or AFL, either as a primary reason for consultation or as a secondary diagnosis, was associated with a high risk of subsequent re-presentation and hospital admission.
authors.affiliation: Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada. Electronic address: redfeard@kgh.kari.net.
authors.forename: Damian P
authors.initials: DP
authors.lastname: Redfearn
authors.affiliation: Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.
authors.forename: Muhammad Ali
authors.initials: MA
authors.lastname: Furqan
authors.affiliation: Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.
authors.forename: Andres
authors.initials: A
authors.lastname: Enriquez
authors.affiliation: Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Barber
authors.affiliation: Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.
authors.forename: Cathy
authors.initials: C
authors.lastname: Shaw
authors.affiliation: Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Simpson
authors.affiliation: Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.
authors.forename: Adrian
authors.initials: A
authors.lastname: Baranchuk
authors.affiliation: Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Michael
authors.affiliation: Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.
authors.forename: Hoshiar
authors.initials: H
authors.lastname: Abdollah
authors.affiliation: Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brison
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D001282:Atrial Flutter / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D002170:Canada / Q000453:epidemiology; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010359:Patient Readmission / Q000639:trends*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015996:Survival Rate / Q000639:trends
chemical_list: D000889:Anti-Arrhythmia Agents