Volume Matters: Improved Outcomes for Patients Presenting to High-Volume Emergency Departments with Atrial Flutter and Fibrillation.
OBJECTIVE
Clinical familiarity plays a role in health outcomes; the relationship between emergency department (ED) volume and outcomes for atrial fibrillation and flutter (AFF) are not clear. We compared ED presentation outcomes for AFF between high (HV) and low volume (LV) EDs in Alberta, Canada.


METHODS
45,372 AFF presentations for patients aged ≥ 35 years from all 104 EDs in Alberta during 1999 to 2011 using administrative health databases formed a retrospective cohort. EDs were grouped by annual AFF volume: 11 high (>100 presentations) or 93 low (≤100 presentations). Outcomes included hospital admission rate, return to ED for AFF within 30 and 90 days, and death within 30 and 90 days. Analyses included statistical tests and mixed effects modeling.


RESULTS
Mean age at ED presentation was 69.8 years (52% male). HV ED presentations were associated with lower admissions (adjusted odds ratio [aOR] = 0.68, 95% confidence interval [CI] 0.64, 0.72; p-value [p]<0.001), ED returns at 90 (aOR = 0.81, 95% CI 0.73, 0.90; p<0.001) days, and a higher likelihood of specialist visits at 30 (aOR = 1.81, 95% CI 1.68, 1.94; p<0.001) and 90 (aOR = 1.82, 95% CI 1.76, 2.03; p<0.001) days. For admitted patients, there were fewer returns to HV EDs at 30 (aOR = 0.37, 95% CI 0.15, 0.87; p = 0.02) and 90 (aOR = 0.48, 95% CI 0.26, 0.89; p = 0.02) days after hospital discharge. There was no difference in death between the two groups.


CONCLUSIONS
AFF patients presenting to HV EDs experienced fewer admissions and AFF ED revisit and higher specialist referrals compared to LV EDs.
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.|Women & Children's Health Research Institute, Edmonton, Alberta, Canada.
Rhonda J
RJ
Rosychuk
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Michelle M
MM
Graham
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.|Alberta Health Services, Edmonton, Alberta, Canada.
Brian R
BR
Holroyd
Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada.|Alberta Health Services, Edmonton, Alberta, Canada.|School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Brian H
BH
Rowe
D000368:Aged; D000416:Alberta; D001281:Atrial Fibrillation / Q000628:therapy*; D001282:Atrial Flutter / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006329:Heart Conduction System; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors