title: Outcomes for Emergency Department Patients With Recent-Onset Atrial Fibrillation and Flutter Treated in Canadian Hospitals.
abstract: OBJECTIVE
  Recent-onset atrial fibrillation and flutter are the most common arrhythmias managed in the emergency department (ED). We evaluate the management and 30-day outcomes for recent-onset atrial fibrillation and flutter patients in Canadian EDs, where cardioversion is commonly practiced.
  
  
  METHODS
  We conducted a prospective cohort study in 6 academic hospital EDs and enrolled patients who had atrial fibrillation and flutter onset within 48 hours. Patients were followed for 30 days by health records review and telephone. Adverse events included death, stroke, acute coronary syndrome, heart failure, subsequent admission, or ED electrocardioversion.
  
  
  RESULTS
  We enrolled 1,091 patients with mean age 63.9 years, atrial fibrillation 84.7%, atrial flutter 15.3%, hospital admission 9.0%, and converted to sinus rhythm 80.1%. Although 10.5% of recent-onset atrial fibrillation and flutter patients had adverse events within 30 days, there were no related deaths and 1 stroke (0.1%). Adjusted odds ratios for factors associated with adverse event were hours from onset (1.03/hour; 95% confidence interval [CI] 1.01 to 1.05), history of stroke or transient ischemic attack (2.09; 95% CI 1.01 to 4.36), and pulmonary congestion on chest radiograph (7.37; 95% CI 2.40 to 22.64). Patients who left the ED in sinus rhythm were much less likely to experience an adverse event (P<.001).
  
  
  CONCLUSIONS
  Although most recent-onset atrial fibrillation and flutter patients were treated aggressively in the ED, there were few 30-day serious outcomes. Physicians underprescribed oral anticoagulants. Potential risk factors for adverse events include longer duration from arrhythmia onset, previous stroke or transient ischemic attack, pulmonary congestion on chest radiograph, and not being in sinus rhythm at discharge. An ED strategy of sinus rhythm restoration and discharge in most patients is effective and safe.
authors.affiliation: Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: istiell@ohri.ca.
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Clement
authors.affiliation: Department of Emergency Medicine and School for Public Health, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.affiliation: Department of Emergency Medicine and Kingston General Hospital Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Brison
authors.affiliation: Libin Cardiovascular Institute/University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: D George
authors.initials: DG
authors.lastname: Wyse
authors.affiliation: University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Birnie
authors.affiliation: Division of Cardiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Dorian
authors.affiliation: Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Eddy
authors.initials: E
authors.lastname: Lang
authors.affiliation: Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Perry
authors.affiliation: Division of Emergency Medicine, Schwartz/Reisman Emergency Medicine Institute, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Bjug
authors.initials: B
authors.lastname: Borgundvaag
authors.affiliation: Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Debra
authors.initials: D
authors.lastname: Eagles
authors.affiliation: Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Damian
authors.initials: D
authors.lastname: Redfearn
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brinkhurst
authors.affiliation: University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada; University of Ottawa School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D001282:Atrial Flutter / Q000150:complications / Q000628:therapy*; D002170:Canada; D004554:Electric Countershock; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult