Atrial Fibrillation/Flutter Outcome Risk Determination
Atrial Fibrillation/Flutter Outcome Risk Determination
It is our hypotheses that 1) readily available Emergency Department data can be utilized in
 an Atrial Fibrillation clinical prediction rule to identify those patients at low or high
 risk for adverse outcomes; 2) Assigned risk can be utilized to drive physician
 decision-making by identifying patients who do not require hospital admission (low risk) and
 patients needing hospitalization (high risk); and 3) a facile version of the AFPR will be
 easily incorporated into standard Emergency Department patient management systems and assist
 physicians with risk stratification of patients presenting with Atrial Fibrillation.
AF: Impact on Present and Future National Health Over 2 million people in the United States
 have Atrial Fibrillation, the most common sustained arrhythmia.1 That number of patients is
 expected to increase to 5.6 million by 2050.1 Atrial Fibrillation is associated with a 4-5
 fold increase in the risk of stroke, 3-fold increase in the risk of heart failure and 1.5-1.9
 increased risk of death.2-6 The prevalence of Atrial Fibrillation increases as individuals
 age; 5.9% of those over 65 years of age and 9% of those over 80 years are diagnosed with the
 arrhythmia.25 The lifetime risk for development of Atrial Fibrillation is estimated to be 1
 in 4 for men and women forty years of age and older.26 The proper management of patients with
 AF is critical due to the well-documented association with heart failure and stroke.2-6, 11,
 27.

 The number of Emergency Department visits for complaints related to Atrial Fibrillation
 increased by 88% between 1993 and 2003 and now account for approximately 1% percent of all
 Emergency Department visits in the United States.7, 24 More than 65% of these Atrial
 Fibrillation visits result in hospital admission and over $6.65 billion in expenditures,
 including $3.88 billion for hospitalizations, $1.53 billion for outpatient treatment and
 nearly $240 million for prescription drugs.8, 24 Patients with a primary admission diagnosis
 of AF had a mean length of stay and hospital charge of 4 days and $7000 in 1999.28 Over the
 past 20 years, the admission rate for Atrial Fibrillation has increased by 66%.29-31 The
 combination of increasing Atrial Fibrillation prevalence, unnecessarily high admission rate
 and Emergency Department crowding is likely to severely burden our healthcare system.
Inclusion Criteria:

 -  ED patients 18 years and older

 -  Provide informed consent

 -  Have a documented diagnosis of AF or atrial flutter on electrocardiogram or rhythm
 strip from an ED, prehospital provider or outside medical facility on day of
 enrollment.

 -  Present with signs (tachycardia, dyspnea) or symptoms (palpitations, chest pain,
 shortness of breath, weakness, lightheadedness, pre-syncope, or syncope) consistent
 with primary symptomatic AF

 -  Patients whose primary complaint is not directly related to their AF diagnosis (e.g.
 evaluation for febrile illness, gastrointestinal complaint, injury) BUT have a
 secondary complaint consistent with symptomatic AF that requires ED evaluation (e.g.
 new AF diagnosis, AF associated with inadequate rate control (defined as resting heart
 rate greater than 100bon), AF associated with heart failure symptoms, AF in the
 setting of CVA or TIA, AF associated with other thromboembolic complications).

 Exclusion Criteria:

 -  Patients who are under the age of 18

 -  Previously enrolled patients

 -  ED patients who present with complaints unrelated to their AF (e.g. sprained
 ankle,pharyngitis) and have adequately rate (<100 bpm at rest) or rhythm
 controlled-AF.