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Trends in Atrial Fibrillation Management—Results from a National Multi-Center Urgent Care Network Registry

Background: Atrial fibrillation (AF) is a common diagnosis in patients presenting to urgent care centers (UCCs), yet there is scant research regarding treatment in these centers. While some of these patients are managed within UCCs, some are referred for further care in an emergency department (ED)....

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Autores principales: Lebovitz, Shalom, Estryk, Menachem, Zimmerman, Deena R., Pollak, Arthur, Luria, David, Amir, Offer, Biton, Yitschak
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10650842/
https://www.ncbi.nlm.nih.gov/pubmed/37959170
http://dx.doi.org/10.3390/jcm12216704
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author Lebovitz, Shalom
Estryk, Menachem
Zimmerman, Deena R.
Pollak, Arthur
Luria, David
Amir, Offer
Biton, Yitschak
author_facet Lebovitz, Shalom
Estryk, Menachem
Zimmerman, Deena R.
Pollak, Arthur
Luria, David
Amir, Offer
Biton, Yitschak
author_sort Lebovitz, Shalom
collection PubMed
description Background: Atrial fibrillation (AF) is a common diagnosis in patients presenting to urgent care centers (UCCs), yet there is scant research regarding treatment in these centers. While some of these patients are managed within UCCs, some are referred for further care in an emergency department (ED). Objectives: We aimed to identify the rate of patients referred to an ED and define predictors for this outcome. We analyzed the rates of AF diagnosis and hospital referral over the years. Finally, we described trends in patient anticoagulation (AC) medication use. Methods: This retrospective study included 5873 visits of patients over age 18 visiting the TEREM UCC network with a diagnosis of AF over 11 years. Multivariate analysis was used to identify predictors for ED referral. Results: In a multivariate model, predictors of referral to an ED included vascular disease (OR 1.88 (95% CI 1.43–2.45), p < 0.001), evening or night shifts (OR 1.31 (95% CI 1.11–1.55), p < 0.001; OR 1.68 (95% CI 1.32–2.15), p < 0.001; respectively), previously diagnosed AF (OR 0.31 (95% CI 0.26–0.37), p < 0.001), prior treatment with AC (OR 0.56 (95% CI 0.46–0.67), p < 0.001), beta blockers (OR 0.63 (95% CI 0.52–0.76), p < 0.001), and antiarrhythmic medication (OR 0.58 (95% CI 0.48–0.69), p < 0.001). Visits diagnosed with AF increased over the years (p = 0.030), while referrals to an ED decreased over the years (p = 0.050). The rate of novel oral anticoagulant prescriptions increased over the years. Conclusions: The rate of referral to an ED from a UCC over the years is declining but remains high. Referrals may be predicted using simple clinical variables. This knowledge may help to reduce the burden of hospitalizations.
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spelling pubmed-106508422023-10-24 Trends in Atrial Fibrillation Management—Results from a National Multi-Center Urgent Care Network Registry Lebovitz, Shalom Estryk, Menachem Zimmerman, Deena R. Pollak, Arthur Luria, David Amir, Offer Biton, Yitschak J Clin Med Article Background: Atrial fibrillation (AF) is a common diagnosis in patients presenting to urgent care centers (UCCs), yet there is scant research regarding treatment in these centers. While some of these patients are managed within UCCs, some are referred for further care in an emergency department (ED). Objectives: We aimed to identify the rate of patients referred to an ED and define predictors for this outcome. We analyzed the rates of AF diagnosis and hospital referral over the years. Finally, we described trends in patient anticoagulation (AC) medication use. Methods: This retrospective study included 5873 visits of patients over age 18 visiting the TEREM UCC network with a diagnosis of AF over 11 years. Multivariate analysis was used to identify predictors for ED referral. Results: In a multivariate model, predictors of referral to an ED included vascular disease (OR 1.88 (95% CI 1.43–2.45), p < 0.001), evening or night shifts (OR 1.31 (95% CI 1.11–1.55), p < 0.001; OR 1.68 (95% CI 1.32–2.15), p < 0.001; respectively), previously diagnosed AF (OR 0.31 (95% CI 0.26–0.37), p < 0.001), prior treatment with AC (OR 0.56 (95% CI 0.46–0.67), p < 0.001), beta blockers (OR 0.63 (95% CI 0.52–0.76), p < 0.001), and antiarrhythmic medication (OR 0.58 (95% CI 0.48–0.69), p < 0.001). Visits diagnosed with AF increased over the years (p = 0.030), while referrals to an ED decreased over the years (p = 0.050). The rate of novel oral anticoagulant prescriptions increased over the years. Conclusions: The rate of referral to an ED from a UCC over the years is declining but remains high. Referrals may be predicted using simple clinical variables. This knowledge may help to reduce the burden of hospitalizations. MDPI 2023-10-24 /pmc/articles/PMC10650842/ /pubmed/37959170 http://dx.doi.org/10.3390/jcm12216704 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lebovitz, Shalom
Estryk, Menachem
Zimmerman, Deena R.
Pollak, Arthur
Luria, David
Amir, Offer
Biton, Yitschak
Trends in Atrial Fibrillation Management—Results from a National Multi-Center Urgent Care Network Registry
title Trends in Atrial Fibrillation Management—Results from a National Multi-Center Urgent Care Network Registry
title_full Trends in Atrial Fibrillation Management—Results from a National Multi-Center Urgent Care Network Registry
title_fullStr Trends in Atrial Fibrillation Management—Results from a National Multi-Center Urgent Care Network Registry
title_full_unstemmed Trends in Atrial Fibrillation Management—Results from a National Multi-Center Urgent Care Network Registry
title_short Trends in Atrial Fibrillation Management—Results from a National Multi-Center Urgent Care Network Registry
title_sort trends in atrial fibrillation management—results from a national multi-center urgent care network registry
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10650842/
https://www.ncbi.nlm.nih.gov/pubmed/37959170
http://dx.doi.org/10.3390/jcm12216704
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