Objectives

To examine the association between specialist consultation and risk of 30-day ED revisit in emergency department (ED) patients with recent-onset uncomplicated atrial fibrillation or flutter (AF/AFL).

Methods

As a secondary analysis of a previously published trial, clinical experts identified predictors of consultation including age and sex, ED sinus conversion, thromboembolic risk, heart rate, rate control medication use, coronary artery disease and anti-platelet use, and chronic obstructive pulmonary disease. These were included in a propensity-matched hierarchical Bayesian model accounting for hospital site as a random effect, with 30-day ED revisit as the primary outcome. We also measured ED length of stay for consulted and non-consulted patients.

Results

We analyzed data from 11 sites for 829 ED patients with AF/AFL, of whom 364 (44%) had specialist consultation. A total of 128 patients (15.4%) had an ED revisit, 78 (16.8%) from the no consult group and 50 (13.7%) from the consult group. Consultation rates ranged from 8.8 to 71% between sites. Median length of stay was 591 min (interquartile range [IQR] 359–1024) for consulted patients and 300 min (IQR 212–409) for patients without consultation. After propensity-matching, consulted patients had a 0.6% (IQR − 4 to 3%) lower risk of 30-day revisits than non-consulted patients (probability of lower risk 55%).

Conclusions

In ED patients with uncomplicated AF/AFL, there was substantial between-site variation in specialist consultations; such consultation was unlikely to influence revisits within 30 days while ED length of stay was nearly double. ED specialist consultations may not be necessary for uncomplicated patients.

中文翻译：

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专科会诊对近期无并发症心房颤动或扑动患者急诊复诊的影响

目标

旨在研究近期发作的无并发症心房颤动或房扑 (AF/AFL) 急诊科 (ED) 患者的专家会诊与 30 天 ED 再次就诊风险之间的关联。

方法

作为对先前发表的试验的二次分析，临床专家确定了会诊的预测因素，包括年龄和性别、 ED 窦转换、血栓栓塞风险、心率、心率控制药物的使用、冠状动脉疾病和抗血小板药物的使用以及慢性阻塞性肺病. 这些包括在倾向匹配的分层贝叶斯模型中，该模型将医院地点作为随机效应考虑在内，以 30 天 ED 重访为主要结果。我们还测量了会诊和未会诊患者的急诊住院时间。

结果

我们分析了来自 11 个中心的 829 名 AF/AFL 急诊科患者的数据，其中 364 名 (44%) 接受了专家会诊。共有 128 名患者 (15.4%) 再次访问急诊室，其中 78 名 (16.8%) 来自未咨询组，50 名 (13.7%) 来自咨询组。站点之间的咨询率从 8.8% 到 71% 不等。就诊患者的中位住院时间为 591 分钟（四分位间距 [IQR] 359-1024），未就诊患者的中位住院时间为 300 分钟（IQR 212-409）。倾向匹配后，会诊患者的 30 天复诊风险比未会诊患者低 0.6%（IQR − 4 至 3%）（风险较低的概率为 55%）。

结论

在患有单纯性 AF/AFL 的 ED 患者中，专家会诊的不同地点之间存在很大差异；这种咨询不太可能影响 30 天内的再次访问，而 ED 的住院时间几乎翻了一番。无并发症的患者可能不需要急诊专家会诊。