School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3000, Australia; Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3000, Australia; Ambulance Victoria, 31 Joseph St, Blackburn North, Victoria 3130, Australia; Department of Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3000, Australia; Monash Alfred Baker Centre for Cardiovascular Research, 55 Commercial Rd, Melbourne, Victoria 3000, Australia.
Ambulance Victoria, 31 Joseph St, Blackburn North, Victoria 3130, Australia.
Int J Cardiol. 2024 Nov 1;414:132397. doi: 10.1016/j.ijcard.2024.132397. Epub 2024 Jul 30.
Atrial fibrillation (AF) is a growing burden on healthcare resources, despite improvements in prevention and management. AF is a common cause of hospitalisation, and Emergency Medical Services (EMS) use. However, there is a paucity of data describing the burden of AF on EMS. We aimed to determine the prevalence, characteristics, and outcomes of patients presenting with AF to EMS using a large population-based sample.
Consecutive attendances for AF in Victoria, Australia (January 2015-June 2019) were included if patients had a diagnosis of "AF" or "arrhythmia" with AF on electrocardiogram. Data were individually linked to emergency, hospital, and mortality records.
Of 2,613,056 EMS attendances, 16,525 were a first attendance for AF and linked to hospital records. Median (IQR) age was 76 (67,84) years (43% female). Seventy-eight percent had high thromboembolic risk (CHADS-VASc score ≥ 2), and 72% had a heart rate ≥ 100 bpm. Forty-two percent of patients received no treatment by paramedics and 99.4% were transported to hospital. Fifty-three percent were discharged from ED. Median length of hospital stay was 2 days. Of 2542 cases reattended for AF, 19% occurred within 30 days, with increased odds for females and those of low socioeconomic status. Overall, 24% died during the study period, 12% within 30 days. Increasing age, heart failure, stroke, COPD, and low socioeconomic status increased the odds of 30-day mortality.
EMS utilisation for AF is common and associated with frequent reattendance. Further studies are required to investigate novel pathways of care to reduce AF burden on healthcare systems.
尽管在预防和管理方面有所改善，房颤（AF）仍是医疗资源的日益负担。AF 是住院和急诊医疗服务（EMS）使用的常见原因。但是，描述 AF 对 EMS 的负担的数据很少。我们旨在使用大型基于人群的样本，确定通过 EMS 就诊的 AF 患者的患病率，特征和结局。
如果患者的心电图上有“ AF”或“心律失常”的诊断为“ AF”，则纳入澳大利亚维多利亚州（2015 年 1 月至 2019 年 6 月）连续就诊的 AF。将数据单独链接到紧急情况，医院和死亡率记录。
在 2613056 次 EMS 就诊中，有 16525 次是首次就诊的 AF，并与医院记录相关联。中位数（IQR）年龄为 76（67，84）岁（43％为女性）。78％的患者具有高血栓栓塞风险（CHADS-VASc 评分≥2），72％的患者心率≥100 bpm。42％的患者未接受护理人员的治疗，99.4％的患者被送往医院。53％的患者从 ED 出院。中位数住院时间为 2 天。在 2542 例因 AF 再就诊的病例中，19％在 30 天内发生，女性和社会经济地位较低的人发生的可能性更高。总体而言，在研究期间有 24％的患者死亡，其中 12％在 30 天内死亡。年龄增长，心力衰竭，中风，COPD 和社会经济地位较低会增加 30 天死亡率的可能性。
AF 对 EMS 的利用很普遍，并且与频繁再就诊有关。需要进一步研究以探索新的护理途径，以减轻 AF 对医疗系统的负担。
