Abstract：
BACKGROUND: Atrial fibrillation (AF) is a growing burden on healthcare resources, despite improvements in prevention and management. AF is a common cause of hospitalisation, and Emergency Medical Services (EMS) use. However, there is a paucity of data describing the burden of AF on EMS. We aimed to determine the prevalence, characteristics, and outcomes of patients presenting with AF to EMS using a large population-based sample.
METHODS: Consecutive attendances for AF in Victoria, Australia (January 2015-June 2019) were included if patients had a diagnosis of \"AF\" or \"arrhythmia\" with AF on electrocardiogram. Data were individually linked to emergency, hospital, and mortality records.
RESULTS: Of 2,613,056 EMS attendances, 16,525 were a first attendance for AF and linked to hospital records. Median (IQR) age was 76 (67,84) years (43% female). Seventy-eight percent had high thromboembolic risk (CHA2DS2-VASc score ≥ 2), and 72% had a heart rate ≥ 100 bpm. Forty-two percent of patients received no treatment by paramedics and 99.4% were transported to hospital. Fifty-three percent were discharged from ED. Median length of hospital stay was 2 days. Of 2542 cases reattended for AF, 19% occurred within 30 days, with increased odds for females and those of low socioeconomic status. Overall, 24% died during the study period, 12% within 30 days. Increasing age, heart failure, stroke, COPD, and low socioeconomic status increased the odds of 30-day mortality.
CONCLUSIONS: EMS utilisation for AF is common and associated with frequent reattendance. Further studies are required to investigate novel pathways of care to reduce AF burden on healthcare systems.
METHODS: Consecutive attendances for AF in Victoria, Australia (January 2015-June 2019) were included if patients had a diagnosis of \"AF\" or \"arrhythmia\" with AF on electrocardiogram. Data were individually linked to emergency, hospital, and mortality records.
RESULTS: Of 2,613,056 EMS attendances, 16,525 were a first attendance for AF and linked to hospital records. Median (IQR) age was 76 (67,84) years (43% female). Seventy-eight percent had high thromboembolic risk (CHA2DS2-VASc score ≥ 2), and 72% had a heart rate ≥ 100 bpm. Forty-two percent of patients received no treatment by paramedics and 99.4% were transported to hospital. Fifty-three percent were discharged from ED. Median length of hospital stay was 2 days. Of 2542 cases reattended for AF, 19% occurred within 30 days, with increased odds for females and those of low socioeconomic status. Overall, 24% died during the study period, 12% within 30 days. Increasing age, heart failure, stroke, COPD, and low socioeconomic status increased the odds of 30-day mortality.
CONCLUSIONS: EMS utilisation for AF is common and associated with frequent reattendance. Further studies are required to investigate novel pathways of care to reduce AF burden on healthcare systems.
摘要：
背景：心房颤动（AF）对医疗保健资源的负担越来越大，尽管在预防和管理方面有所改善。房颤是住院的常见原因，和紧急医疗服务（EMS）使用。然而,缺乏描述AF对EMS的负担的数据。我们的目的是确定患病率，特点,以及使用基于人群的大样本对出现房颤的患者进行EMS治疗的结果。
方法：在维多利亚州连续参加AF，澳大利亚（2015年1月至2019年6月）如果患者在心电图上诊断为“房颤”或“心律失常”伴房颤，则纳入研究。数据分别与紧急情况联系在一起，医院,和死亡率记录。
结果：在2,613,056名EMS出勤率中，16,525是房颤的首次就诊，并与医院记录相关联。年龄中位数（IQR）为76（67,84）岁（43%为女性）。78％的人有较高的血栓栓塞风险（CHA2DS2-VASc评分≥2），72%的患者心率≥100bpm.42％的患者没有接受护理人员的治疗，99.4％的患者被送往医院。53%从ED出院。平均住院时间为2天。在2542例房颤患者中，19%发生在30天内，女性和社会经济地位低的女性的几率增加。总的来说,24%在研究期间死亡，30天内12%。年龄增长,心力衰竭,中风,COPD,低社会经济地位增加了30天死亡率的几率.
结论：EMS用于房颤是常见的，并且与频繁的就诊相关。需要进一步的研究来研究新的护理途径，以减轻医疗保健系统的AF负担。
方法：在维多利亚州连续参加AF，澳大利亚（2015年1月至2019年6月）如果患者在心电图上诊断为“房颤”或“心律失常”伴房颤，则纳入研究。数据分别与紧急情况联系在一起，医院,和死亡率记录。
结果：在2,613,056名EMS出勤率中，16,525是房颤的首次就诊，并与医院记录相关联。年龄中位数（IQR）为76（67,84）岁（43%为女性）。78％的人有较高的血栓栓塞风险（CHA2DS2-VASc评分≥2），72%的患者心率≥100bpm.42％的患者没有接受护理人员的治疗，99.4％的患者被送往医院。53%从ED出院。平均住院时间为2天。在2542例房颤患者中，19%发生在30天内，女性和社会经济地位低的女性的几率增加。总的来说,24%在研究期间死亡，30天内12%。年龄增长,心力衰竭,中风,COPD,低社会经济地位增加了30天死亡率的几率.
结论：EMS用于房颤是常见的，并且与频繁的就诊相关。需要进一步的研究来研究新的护理途径，以减轻医疗保健系统的AF负担。
