Increasing US emergency department visit rates and subsequent hospital admissions for atrial fibrillation from 1993 to 2004.

STUDY OBJECTIVE: Atrial fibrillation is a significant public health problem that is becoming increasingly prevalent. The clinical epidemiology of US emergency department (ED) visits for atrial fibrillation is uncertain. This study seeks to describe recent trends in ED visits for atrial fibrillation. METHODS: ED visits with a primary diagnosis of atrial fibrillation were analyzed using data from the US National Hospital Ambulatory Medical Care Survey, 1993 to 2004. RESULTS: During the 12-year period, there were approximately 2.7 million (95% confidence interval [CI] 2.4 to 3.0 million) ED visits for atrial fibrillation in the United States, and the population-adjusted visit rate increased from 0.6 to 1.2 per 1,000 US population (P for trend=.02). Similarly, the absolute number of visits increased 88%, from 300,000 (95% CI 209,000 to 392,000) in 1993 to 1994 to 564,000 (95% CI 423,000 to 705,000) in 2003 to 2004. Approximately 64% (95% CI 59% to 69%) of these patients were admitted to the hospital, a rate that remained constant throughout the 12-year period (P for trend=.73). Admission rates were significantly lower in the western region of the United States (48%; 95% CI 36% to 60% versus 76%; in the Northeast, 95% CI 68% to 84%). Patient characteristics and ED management did not materially differ by admission status. In a multivariate model, congestive heart failure was the only predictor of admission but accounted for only 14% of admissions. CONCLUSION: From 1993 to 2004, the population-adjusted rate of ED visits for atrial fibrillation increased, whereas the proportion admitted to the hospital remained stable. Patient characteristics and ED management were similar regardless of admission status, and there were relatively few predictors of admission.

U.S. emergency department visits for supraventricular tachycardia, 1993-2003.

BACKGROUND: Supraventricular tachycardia (SVT) is often described as a recurrent condition that leads to emergency department (ED) visits. However, the epidemiology of ED visits for SVT is unknown. OBJECTIVES: To define the frequency of SVT in U.S. EDs and to analyze patient characteristics, ED management, and disposition for such visits. METHODS: The authors analyzed data from the National Hospital Ambulatory Medical Care Survey, 1993-2003. SVT cases were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes 426.7 or 427.0 in any of the three diagnostic fields. RESULTS: Of the 1.1 billion ED visits over the 11-year study period, an estimated 555,000 (0.05%; 95% confidence interval [CI] = 0.04% to 0.06%) were related to SVT. The annual frequency and population rate appear stable between 1993 and 2003 (p for trend = 0.35). Compared with non-SVT visits, those with SVT were more likely to be older than 65 years of age (26% vs. 15%, p < 0.01) and female (70% vs. 53%, p < 0.01). Electrocardiograms were documented for most visits (91%; 95% CI = 85% to 96%). Approximately half of the patients (51%; 95% CI = 40% to 61%) received an atrioventricular nodal blocking medication, most frequently adenosine (26%; 95% CI = 17% to 36%). SVT visits ended in hospital admission for 24% (95% CI = 15% to 34%). At the other extreme, 44% (95% CI = 32% to 56%) were discharged without planned follow-up. CONCLUSIONS: Supraventricular tachycardia accounts for approximately 50,000 ED visits each year. Higher visit rates in older adults and female patients are consistent with prior studies of SVT in the general population. This study provides an epidemiologic foundation that will enable future research to assess and improve clinical management strategies of SVT in the ED.

US emergency department visits for alcohol-related diseases and injuries between 1992 and 2000.

BACKGROUND: Alcohol-related diseases and injuries pose a significant burden on hospital emergency departments (EDs). Recognized limitations of self-reported data suggest that previous single-year national studies may have underestimated the magnitude of this burden. METHODS: Data were obtained from the National Hospital Ambulatory Medical Care Survey for 1992 through 2000. Thirty-seven alcohol-related diagnoses and their corresponding alcohol-attributable fractions (AAFs) were used to estimate the number of ED visits attributable to alcohol. Diagnoses with an AAF of 1 were analyzed by age, sex, and race. Disposition to inpatient settings and alcohol screening also were examined. RESULTS: During these 9 years, there were an estimated 68.6 million (95% confidence interval [CI], 65.6 million to 71.7 million) ED visits attributable to alcohol, a rate of 28.7 (95% CI, 27.1-30.3) per 1000 US population. The number of alcohol-related visits increased 18% during this period. Visit rates for diagnoses with AAFs of 1 were highest for those who were aged 30 through 49 years, male, and black. From 1992 to 2000, these disparities remained stable for age group but significantly changed for sex (+22%) and race (-76%). Most patients with diagnoses with AAFs of 1 were not admitted to an inpatient unit, and the percentage of patients who underwent blood alcohol concentration testing was substantially lower than corresponding AAFs. CONCLUSIONS: Alcohol-related ED visits are approximately 3 times higher than previous estimates determined by physician documentation or patient disclosure of alcohol involvement. Rising trends, changing disparities, and suboptimal ED management of such visits are a call to action.