Predictors of Regional Variations in Hospitalizations Following Emergency Department Visits for Atrial Fibrillation

Study Questions:

What is the percentage of visits resulting in hospitalization for atrial fibrillation (AF), and the associations between patient and hospital characteristics with hospitalization at the national and regional levels?


The investigators conducted a cross-sectional study of adults with AF listed as the primary emergency department (ED) diagnosis in the 2007 to 2009 Nationwide Emergency Department Sample. They performed multivariate logistic regression analyses investigating the associations between prespecified patient and hospital characteristics with hospitalization.


From 2007 to 2009, there were 1,320,123 weighted ED visits for AF, with 69% hospitalized nationally. Mean regional hospitalization proportions were: Northeast (74%), Midwest (68%), South (74%), and West (57%). The highest odds ratios for predicting hospitalization were heart failure (3.85; 95% confidence interval [CI], 3.66-4.02), chronic obstructive pulmonary disease (2.47; 95% CI, 2.34-2.61), and coronary artery disease (1.65; 95% CI, 1.58-1.73). After adjusting for age, privately insured (0.77; 95% CI, 0.73-0.81) and self-pay (0.77; 95% CI, 0.66-0.90) patients had lower odds compared with Medicare recipients, whereas Medicaid (1.21; 95% CI, 1.11-1.32) patients tended to have higher odds. Patients living in low-income zip codes (1.18; 95% CI, 1.12-1.25) and patients treated at large metropolitan hospitals (1.75; 95% CI, 1.59-1.93) had higher odds.


The authors concluded that there is considerable regional variation in the management of patients with AF in the ED, and in associations between patient socioeconomic and hospital characteristics with ED disposition.


This study reported that there are considerable regional differences in AF hospitalizations and striking differences in ED AF management based on region, insurance, hospital type, and socioeconomics. These results suggest that health care disparities are associated with AF treatment in the United States, specifically resulting in more frequent hospitalizations among patients seen at hospitals that primarily serve uninsured and underinsured patients. Better understanding of these differences would generate opportunities for the delivery of more standardized treatment regimens with improved care and more efficient resource utilization. Given the increasing AF prevalence and the rising number of ED visits for AF, identifying strategies that will reduce the number of hospitalizations, while optimizing quality of care, needs to be a health care priority.

Keywords: Multivariate Analysis, Cross-Sectional Studies, Hospitalization, Logistic Models

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