Atrial fibrillation in the emergency department: Predictors of admission and discharge—A nationwide analysis

Abstract

Background

Atrial fibrillation (AF) is a commonly encountered cardiac arrhythmia. Its presentation in the emergency department (ED) has significant clinical and economic implications, warranting further investigation.

Objective

The purpose of this study was to analyze predictors of disposition and identify disparities among patients presenting to US EDs with AF.

Methods

In this retrospective study, we analyzed data from patient visits to the ED with a primary diagnosis of AF using the Nationwide Emergency Department Sample from January 1, 2016, to December 31, 2020. We compared demographic characteristics, comorbidities, and disposition status for these patients.

Results

A total of 699,680,000 adult ED visits were recorded, of which 3,070,240 were for AF. Nearly half (48.4%) of patients with AF in the ED required inpatient admission, while ED mortality was extremely low (0.03%). Patients aged 80 years or older (compared with those aged 18–44 years) were more likely to be admitted than discharged home (odds ratio 1.15; 95% confidence interval 1.07–1.24; P < .001), and women were more likely to be admitted than men (odds ratio 1.12; 95% confidence interval 1.10–1.13; P < .001). Comorbidities such as chronic pulmonary disease, essential hypertension, obesity, renal failure, liver disease, neurologic disorders, iron deficiency anemia, hypothyroidism, valvular disease, and hyperlipidemia, along with lifestyle factors such as smoking, alcohol consumption, or recreational drug use, also increased the likelihood of hospital admission.

Conclusion

Our study reveals that older age, female sex, and certain comorbidities significantly increase the likelihood of hospital admission for patients with AF in the ED.