Increasing US emergency department visit rates and subsequent hospital admissions for atrial fibrillation from 1993 to 2004
Increasing US emergency department visit rates and subsequent hospital admissions for atrial fibrillation from 1993 to 2004
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DOI：
10.1016/j.annemergmed.2007.03.007
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发表时间：
2008-01-01
影响因子：
6.2
通讯作者：
Carnargo, Carlos A., Jr.
中科院分区：
文献类型：
--
作者：
McDonald, Alden J.;Pelletier, Andrea J.;Carnargo, Carlos A., Jr.
研究目的：心房颤动是一个日益普遍的重要公共卫生问题。美国急诊科 (ED) 因房颤就诊的临床流行病学尚不确定。本研究旨在描述房颤急诊就诊的最新趋势。方法：使用 1993 年至 2004 年美国国家医院门诊医疗调查的数据对初步诊断为心房颤动的急诊就诊进行分析。结果：在 12 年期间，美国约有 270 万（95% 置信区间 [CI] 2.4 至 300 万）急诊就诊为房颤，人口调整就诊率从 0.6 增加到 1.2每 1,000 名美国人口（趋势 P=.02）。同样，绝对就诊次数增加了 88%，从 1993 年至 1994 年的 300,000 次（95% CI 209,000 至 392,000）增加到 2003 年至 2004 年的 564,000 次（95% CI 423,000 至 705,000）。约 64%（95% CI 59%至这些患者中有 69% 入院，该比率在整个 12 年期间保持不变（趋势 P = 0.73）。美国西部地区的入院率明显较低（48%；95% CI 36% 至 60%，而东北地区为 76%；95% CI 68% 至 84%）。患者特征和急诊管理并没有因入院状态而存在重大差异。在多变量模型中，充血性心力衰竭是入院的唯一预测因素，但仅占入院人数的 14%。结论：从1993年到2004年，人口调整后的房颤急诊就诊率有所上升，而入院比例保持稳定。无论入院状态如何，患者特征和急诊管理都是相似的，并且入院的预测因素相对较少。
Study objective: Atrial fibrillation is a significant public health problem that is becoming increasingly prevalent. The clinical epidemiology of US emergency department (ED) visits for atrial fibrillation is uncertain. This study seeks to describe recent trends in ED visits for atrial fibrillation. Methods: ED visits with a primary diagnosis of atrial fibrillation were analyzed using data from the US National Hospital Ambulatory Medical Care Survey, 1993 to 2004. Results: During the 12-year period, there were approximately 2.7 million (95% confidence interval [CI] 2.4 to 3.0 million) ED visits for atrial fibrillation in the United States, and the population-adjusted visit rate increased from 0.6 to 1.2 per 1,000 US population (P for trend=.02). Similarly, the absolute number of visits increased 88%, from 300,000 (95% CI 209,000 to 392,000) in 1993 to 1994 to 564,000 (95% Cl 423,000 to 705,000) in 2003 to 2004. Approximately 64% (95% CI 59% to 69%) of these patients were admitted to the hospital, a rate that remained constant throughout the 12-year period (P for trend =.73). Admission rates were significantly lower in the western region of the United States (48%; 95% CI 36% to 60% versus 76%; in the Northeast, 95% CI 68% to 84%). Patient characteristics and ED management did not materially differ by admission status. In a multivariate model, congestive heart failure was the only predictor of admission but accounted for only 14% of admissions. Conclusion: From 1993 to 2004, the population-adjusted rate of ED visits for atrial fibrillation increased, whereas the proportion admitted to the hospital remained stable. Patient characteristics and ED management were similar regardless of admission status, and there were relatively few predictors of admission.