A Population-Based Description of Atrial Fibrillation in the Emergency Department, 2002 to 2010
A Population-Based Description of Atrial Fibrillation in the Emergency Department, 2002 to 2010
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DOI：
10.1016/j.annemergmed.2013.06.005
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发表时间：
2013-12-01
影响因子：
6.2
通讯作者：
Dorian, Paul
中科院分区：
文献类型：
--
作者：
Atzema, Clare L.;Austin, Peter C.;Dorian, Paul
研究目的：我们旨在描述急诊科房颤患者的人口学特征、护理和转归，以及随时间的变化。方法：在这项回顾性队列研究中，我们使用了一个全省范围的数据库，以确定2002年4月至2010年3月在安大略省非儿科急诊科接受治疗的所有最初诊断为房颤的成人患者。结果：在8年的研究期间，113,786名患者因心房颤动进行了143,003次急诊，占所有急诊的0.5%。在2002至2010年间，每年的急症室就诊次数从15,931次增加到20,168次(29.4%；95%可信区间28.7%到30.1%)，而粗略的比率从每10万人172次增加到每10万人195次。中位年龄为72.0岁(四分位数范围从61.0岁到80.0岁)，50.8%是女性，在研究期间这一比例没有显著变化。因心脏复律而向医生收费的急诊指数百分比从6.3%(95%可信区间5.9%至6.7%)上升至11.8%(95%可信区间11.3%至12.3%)。尽管CHADS2评分大于或等于2的患者比例从49.3%(95%CI 48.4%至50.2%)增加到53.6%(95%CI 52.9%至54.4%)，高敏感度ED分流评分从41.1%(95%CI 40.2%至42.0%)增至62.5%(95%CI 61.7%至63.2%)，住院率从48.1%(95%CI 47.3%至49.0%)降至38.4%(95%CI 37.6%至39.2%)。30d死亡率为3.3%(95%CI 3.2%~3.4%)，在研究期间呈轻微下降趋势(P=0.05)，而因房颤或卒中而在30d内住院(2.8%；95%CI 2.7%~2.9%)和重复急诊(7.3%；95%Cl7.1%~7.4%)保持不变。结论：8年间因房颤就诊的急诊次数显著增加。尽管该省急诊科似乎正在治疗风险略高的患者，但入院的患者较少，死亡率也没有增加。
Study objective: We aimed to describe the demographics, care, and outcomes of patients with atrial fibrillation in the emergency department (ED), as well as temporal changes over time.Methods: In this retrospective cohort study, we used a province-wide database to identify all adult patients who were treated in a nonpediatric ED in the province of Ontario with a primary diagnosis of atrial fibrillation, April 2002 to March 2010. We determined the frequency and rate of ED visits and assessed patient demographics, ED care, and outcomes, both overall and by year.Results: During the 8-year study period, 113,786 patients made 143,003 ED Visits for atrial fibrillation, accounting for 0.5% of all ED visits. The annual number of ED visits increased from 15,931 to 20,168 (29.4%; 95% confidence interval [Cl] 28.7% to 30.1%) between 2002 and 2010, whereas the crude rate increased from 172 per 100,000 to 195 per 100,000 persons. Median age was 72.0 years (Interquartile range 61.0 to 80.0 years) and 50.8% were women, which did not change significantly during the study period. The percentage of index ED visits with a physician billing for cardioversion increased from 6.3% (95% Cl 5.9% to 6.7%) to 11.8% (95% Cl 11.3% to 12.3%). Although the percentage of patients with a CHADS2 score greater than or equal to 2 increased from 49.3% (95% Cl 48.4% to 50.2%) to 53.6% (95% Cl 52.9% to 54.4%) and high-acuity ED triage scores increased from 41.1% (95% Cl 40.2% to 42.0%) to 62.5% (95% Cl 61.7% to 63.2%), hospital admissions decreased from 48.1% (95% Cl 47.3% to 49.0%) to 38.4% (95% Cl 37.6% to 39.2%). Thirty-day mortality was 3.3% (95% Cl 3.2% to 3.4%) and showed a slight downward trend during the study period (P=.05), whereas subsequent hospitalizations within 30 days for atrial fibrillation or stroke (2.8%; 95% Cl 2.7% to 2.9%) and repeated ED visits (7.3%; 95% Cl 7.1% to 7.4%) remained unchanged.Conclusion: The number of ED visits for atrial fibrillation increased markedly during an 8-year period. Although it appears that slightly higher-risk patients are being treated in the province's EDs, fewer patients are being admitted to the hospital, and mortality rates have not increased.