Risk Factors of a Serious Underlying Cause of Palpitations Among Patients Attending an Emergency Department

Palpitations are a common reason for calling 911 or visiting the emergency department (ED). The objective of this study was to identify risk factors of a serious underlying cause of palpitations that can be evaluated without an electrocardiogram (ECG).

This observational cohort study took place from January 1 to June 30, 2019 in an academic ED. Patients aged > 18 years who visited the ED for palpitations were included. The primary outcome was a final diagnosis of a serious underlying cause of palpitations at ED discharge. We used backward stepwise logistic regression to identify independent risk factors of a serious cause of palpitations.

A total fo 215 patients were analyzed, including 80 (37%) with a serious underlying cause of palpitations. Four independent risk factors were associated with significant arrhythmia: age ≥ 50 years (odds ratio [OR] = 7.6; 95% confidence interval [CI] = 3.5-16.4), history of heart disease (OR = 4.7; 95% CI = 2.3-9.6), syncope as an associated symptom (OR = 11; 95% CI = 1.4-84.1), and tachycardia ≥ 100 beats per minute (OR = 3.8; 95% CI = 1.8-8.1). A total of 54 patients (25%) had no risk factors. Absence of a risk factor had a sensitivity of 96% (95% CI = 89%-99%), and a specificity of 38% (95% CI = 30%-46%).

We found 4 independent risk factors associated with a serious underlying cause of palpitations at ED triage.