Department of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
BMJ Open. 2020 Apr 16;10(4):e033482. doi: 10.1136/bmjopen-2019-033482.
The primary objective of this study was to ascertain the reasons for emergency department (ED) attendance among patients with a history of atrial fibrillation (AF).
Appropriate ED attendance was defined by the requirement for an electrical or chemical cardioversion and/or an attendance resulting in hospitalisation or administration of intravenous medications for ventricular rate control. Quantitative and qualitative responses were recorded and analysed using descriptive statistics and content analysis, respectively. Random effects logistic regression was performed to estimate the OR of inappropriate ED attendance based on clinically relevant patient characteristics.
Participants ≥18 years with a documented history of AF were approached in one of eight centres partaking in the study across Canada (Ontario, Nova Scotia, Alberta and British Columbia).
Of the 356 patients enrolled (67±13, 45% female), the majority (271/356, 76%) had inappropriate reasons for presentation and did not require urgent ED treatment. Approximately 50% of patients(172/356, 48%) were driven to the ED due to symptoms, while the remainder presented on the basis of general fear or anxiety (67/356, 19%) or prior medical advice (117/356, 33%). Random effects logistic regression analysis showed that patients with a history of congestive heart failure were significantly more likely to seek urgent care for appropriate reasons (p=0.03). Likewise, symptom-related concerns for ED presentation were significantly less likely to result in inappropriate visitation (p=0.02). When patients were surveyed on alternatives to ED care, the highest proportion of responses among both groups was in favour of specialised rapid assessment outpatient clinics (186/356, 52%). Qualitative content analysis confirmed these results.
Improved education focused on symptom management and alleviating disease-related anxiety as well as the institution of rapid access arrhythmias clinics may reduce the need for unnecessary healthcare utilisation in the ED and subsequent hospitalisation.
NCT03127085.
本研究的主要目的是确定有房颤（AF）病史的患者到急诊科（ED）就诊的原因。
适当的 ED 就诊定义为需要电或化学复律，和/或就诊导致住院或静脉内药物治疗心室率控制。使用描述性统计和内容分析分别记录和分析定量和定性反应。使用随机效应逻辑回归根据临床相关患者特征估计不适当 ED 就诊的 OR。
在加拿大（安大略省、新斯科舍省、艾伯塔省和不列颠哥伦比亚省）的 8 个中心之一参与该研究的≥18 岁且有记录的 AF 病史的患者。
在纳入的 356 名患者（67±13，45%女性）中，大多数（271/356，76%）就诊的原因不恰当，不需要紧急 ED 治疗。约 50%的患者（172/356，48%）因症状而被送往 ED，其余的则是基于一般的恐惧或焦虑（67/356，19%）或之前的医疗建议（117/356，33%）。随机效应逻辑回归分析显示，有充血性心力衰竭病史的患者因适当原因寻求紧急护理的可能性显著更高（p=0.03）。同样，与症状相关的 ED 就诊考虑显著不太可能导致不适当就诊（p=0.02）。当对 ED 护理的替代方案进行调查时，两组患者中比例最高的回答是赞成专门的快速评估门诊（186/356，52%）。定性内容分析证实了这些结果。
加强对症状管理和减轻与疾病相关的焦虑的教育，以及建立快速通道心律失常诊所，可能会减少不必要的 ED 就诊和随后住院的医疗需求。
NCT03127085。
