Introduction: With the aging of the population, the large number of patients seen in the emergency department for atrial fibrillation (AF) will continue to rise. Currently 11% die within one year of the visit.
Objective: To examine the impact of rapid (within 3 days) and early (within 7 days) outpatient follow-up care, versus delayed or no follow-up care, on outcomes in AF patients discharged from an emergency department.
Methods: In this retrospective cohort study using comprehensive administrative health data from all 163 emergency departments in the province of Ontario, Canada, we identified patients aged ≥ 18 years who were discharged from an emergency department with a primary diagnosis of AF between April 2007 and March 2014. We used a propensity-score matched landmark analysis to assess the association of rapid and early follow-up care with one-year and 90-day all-cause mortality, cardiovascular hospitalizations, and 30-day return emergency department visits. Logistic regression modelling was used to assess oral anticoagulation (OAC) use at one-year.
Results: For the 10,705 patients with rapid follow-up care who were propensity-score matched to a patient who had follow-up care between days 4 and 7, the hazard of a return ED visit was reduced by 11% (HR 0.89; 95% CI, 0.81-0.99). Rapid care was not associated with mortality or hospitalization. For the 21,883 patients with early follow-up care who were matched to a patient without it, the rate of one-year mortality was 12% lower (HR 0.88; 95% CI, 0.81-0.95), while the rate of ED returns within 30 days was increased (HR 1.69; 95% CI, 1.56-1.83), as was the rate of hospitalization within 90 days (HR 1.30; 95% CI, 1.20-1.39). Among patients who survived to fill a prescription at one year, those who had early follow-up care were two-thirds more likely to fill an OAC prescription a year later, compared to those without early follow-up (OR 1.64; 95% CI 1.54-1.78).
Conclusions: Follow-up care after discharge from an emergency department with AF was associated with a 12% decrease in the rate of death within one year, which may be mediated by more intensive hospital-based care, and/or higher use of evidence-based stroke prevention therapy.