title: Predictors and clinical outcomes of inpatient versus ambulatory management after an emergency department visit for atrial fibrillation: A population-based study.
abstract: BACKGROUND
  There is substantial variation in the management of atrial fibrillation (AF) in the emergency department (ED), particularly whether these patients are admitted to hospital. We sought to identify factors that predict admission and to examine the relationship between AF admission and outcomes.
  
  
  METHODS
  We performed a retrospective cohort analysis of patients ≥20 years of age who had an index ED visit with a primary diagnosis of AF from between April 1, 2005, and March 31, 2010, in Ontario, Canada. We excluded patients who died during the index ED visit or hospitalization. A hierarchical logistic regression model was used to determine predictors of hospital admission during the index ED visit. A propensity-matched analysis was used to test for associations between hospital admission and 1-year outcomes.
  
  
  RESULTS
  The cohort consisted of 33,699 patients, of whom 16,270 (48.3%) were admitted to hospital. Substantial variation was seen across the 154 hospitals, with admission rates ranging from 3.0% to 91.0%. Admitted patients had higher rates of comorbidities compared to discharged patients. Mortality rates at 1 year were significantly higher in matched admitted versus discharged patients (hazard ratio 1.45, 95% CI 1.33-1.57, P < .001), as were all-cause hospitalizations (hazard ratio 1.18, 95% CI 1.13-1.22, P < .001).
  
  
  CONCLUSIONS
  Wide practice variation was observed between hospitals in terms of the proportion of patients admitted. Our data suggest that selected patients when discharged have similar or improved outcomes compared to those who are initially admitted. Future research is needed to better standardize admission/discharge decisions for AF patients in the ED.
authors.affiliation: University of Toronto, Toronto, ON, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Tran
authors.affiliation: University of Toronto, Toronto, ON, Canada; Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Bennell
authors.affiliation: University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada.
authors.forename: Feng
authors.initials: F
authors.lastname: Qiu
authors.affiliation: University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada; Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
authors.affiliation: University of Toronto, Toronto, ON, Canada; Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Sheldon M
authors.initials: SM
authors.lastname: Singh
authors.affiliation: University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada; Division of Cardiology and Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.affiliation: University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada; Trauma, Emergency & Critical Care Research Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.
authors.forename: Clare L
authors.initials: CL
authors.lastname: Atzema
authors.affiliation: University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada; Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada; Peter Munk Cardiac Centre of the University Health Network-Toronto General Hospital, Toronto, ON, Canada.
authors.forename: R Sacha
authors.initials: RS
authors.lastname: Bhatia
authors.affiliation: University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada; Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Peter Munk Cardiac Centre of the University Health Network-Toronto General Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: harindra.wijeysundera@sunnybrook.ca.
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
mesh_terms: D000368:Aged; 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; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data*; D009864:Ontario / Q000453:epidemiology; D011159:Population Surveillance; D011379:Prognosis; D012189:Retrospective Studies