Bradycardia in Older Patients in a Single-Center Emergency Department: Incidence, Characteristics and Outcomes

Abstract

Objective This study aimed to explore data associated with the characteristics, incidence, and outcomes of older patients with symptomatic bradycardia presenting to the emergency department (ED). Methods We prospectively reviewed data of all patients aged 60 years and older who visited our ED with symptomatic bradycardia during 8AM-12PM between June 4, 2018, and June 10, 2019. The outcomes were the incidence of symptomatic bradycardia and adverse events (recurrent bradycardia, rate of ED revisits, subsequent hospitalization, mortality rate, and composite outcomes) at 30 days and 180 days. Results A total of 3297 patients visited the ED. Of these, 205 patients had symptomatic bradycardia. The incidence of symptomatic bradycardia was 6.2% (205/3297). One hundred fourteen patients (55.7%) were female, and the mean age was 74.9 (SD, 9) years. One-third of bradycardia patients (80 patients [39.0%]) were admitted to the hospital, 32 of whom because of unstable bradycardia. Ten of these 32 (30%) patients died during hospitalization from causes unrelated to bradycardia. One-third of unstable bradycardia patients had dyspnea (10/32 patients [31.3%]) followed by chest pain and altered mental status, respectively. ED revisit was the most common adverse event after 30 days (10.8%) and 180 days (20.3%). End-stage renal disease with hemodialysis was associated with adverse outcomes at 30 days (odds ratio, 2.34; 95% confidence interval, 1.30–20.87). Conclusion The incidence of symptomatic bradycardia among older adults was 6.2% in one urban ED. End-stage renal disease with hemodialysis was associated with adverse outcomes at 30 days. Larger studies should confirm this association and investigate methods of minimizing adverse outcomes.

An overview of brady dysrhythmias in the emergency department

“…The following symptoms of unstable bradycardia include hypotension, abruptly altered mental status, ischemic chest pain, and heart failure. 2 The cardiac conduction system is susceptible to momentary or chronic malfunction. As a result, there may be a drop-in heart rate and symptoms from decreased cardiac output.…”