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ObjectivesThe primary objective of this study was to ascertain the reasons for emergency department (ED) attendance among patients with a history of atrial fibrillation (AF).DesignAppropriate ED attendance was defined by the requirement for an electrical or chemical cardioversion and/or an attendance resulting in hospitalisation or administration of intravenous medications for ventricular rate control. Quantitative and qualitative responses were recorded and analysed using descriptive statistics and content analysis, respectively. Random effects logistic regression was performed to estimate the OR of inappropriate ED attendance based on clinically relevant patient characteristics.ParticipantsParticipants ≥18 years with a documented history of AF were approached in one of eight centres partaking in the study across Canada (Ontario, Nova Scotia, Alberta and British Columbia).ResultsOf the 356 patients enrolled (67±13, 45% female), the majority (271/356, 76%) had inappropriate reasons for presentation and did not require urgent ED treatment. Approximately 50% of patients(172/356, 48%) were driven to the ED due to symptoms, while the remainder presented on the basis of general fear or anxiety (67/356, 19%) or prior medical advice (117/356, 33%). Random effects logistic regression analysis showed that patients with a history of congestive heart failure were significantly more likely to seek urgent care for appropriate reasons (p=0.03). Likewise, symptom-related concerns for ED presentation were significantly less likely to result in inappropriate visitation (p=0.02). When patients were surveyed on alternatives to ED care, the highest proportion of responses among both groups was in favour of specialised rapid assessment outpatient clinics (186/356, 52%). Qualitative content analysis confirmed these results.ConclusionsImproved education focused on symptom management and alleviating disease-related anxiety as well as the institution of rapid access arrhythmias clinics may reduce the need for unnecessary healthcare utilisation in the ED and subsequent hospitalisation.Trial registration numberNCT03127085

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Of 3,080 patients, 42% were female. Women with ECG-documented AF were significantly older than men (81AE8 vs. 77AE7 years, p < 0.0001). Clinical characteristics of hospitalized patients by gender are described in Table 1. Among high stroke risk hospitalized patients with a CHADS2!2, there was no difference between anticoagulant use at discharge in women vs. men; warfarin (49% vs. 46%, p¼NS) or novel oral anticoagulants (NOAC) (11% vs. 10%, p¼NS). Among hospitalized patients between the ages of 65-74 years old, slightly more women than men were on warfarin (43% vs. 37%, p¼0.0495). NOAC use was similar between genders at hospital discharge (10% vs. 8%, p¼NS). Among hospitalized patients over the age of 75 years old, there was no significant difference in the prescription of warfarin between women and men (48% vs. 46%, p¼NS) or NOACs (9% vs. 9%, p¼ NS). CONCLUSION: Among patients admitted to an academic hospital with ECG-documented AF and guideline-indicated for stroke prevention with anticoagulants, there was no difference in anticoagulant use between men and women at hospital discharge. Overall, anticoagulant use appears to be suboptimal.