Trends and Predictors of Emergency Department Outcomes in Atrial Fibrillation: A Statewide Analysis from North...

The population burden of atrial fibrillation (AF) continues to rise, leading to significant implications for emergency departments (EDs) managing acute presentations and complications. In this study, we aimed to characterize statewide trends in ED visits, admissions, and mortality related to AF, evaluate the association of AF outcomes with heart failure (HF) subtypes, and identify demographic and clinical predictors of these outcomes.

This retrospective statewide analysis utilized ED data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) from 2016 to 2023. AF encounters were identified using ICD-10-CM diagnosis codes (I48.0-I48.2). Multivariable logistic regression was performed to evaluate predictors of hospital admission and mortality.

Among 39,445,680 ED visits, 517,722 (1.3%) had a diagnosis of AF. AF-related visits peaked in 2018 and declined significantly during the COVID-19 pandemic but recovered to previous levels by 2023. Hospital admission rates remained consistently high (63.7%-73.3%), whereas intra-encounter mortality was low but increased after 2020 (0.2% [pre-2020] to 0.6% [post-2020]). Patients with concomitant HF had increased odds of admission (HfpEF, OR 2.16; 95% CI [2.11-2.21]; HfrEF, OR 2.43; 95% CI [2.36-2.50]). In models evaluating intra-encounter mortality, AF + HFrEF (OR, 1.30; 95% CI [1.05-1.60]) but not AF + HFpEF (OR, 1.13; 95% CI [0.92-1.37]) was significantly associated with increased mortality; in subanalyzes excluding infectious presentations, AF + HFrEF was still associated with increased mortality (OR, 1.56; 95% CI [1.20-2.03]).

These findings highlight continued clinical complexity and disparities in AF management in a large statewide syndromic surveillance database, particularly the association of comorbid HF and AF in emergent settings. Population-wide surveillance of AF can help assess the need for improved outpatient care, especially in populations with comorbid HF or high-risk and underserved populations.