Can J Emerg Med
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Atrial fibrillation or flutter (AFF) patients with renal impairment have poor long-term prognosis, but their emergency department (ED) management has not been described. We investigated the association of renal impairment upon outcomes after rate or rhythm control (RRC) including ED-based adverse events (AE) and treatment failure. ⋯ Of 1,112 consecutive ED AFF patients, 412 (37.0%) had a low eGFR. Crude AE rates for RRC were 27/238 (11.3%) for patients with normal renal function and 26/103 (25.2%) for patients with low eGFR. For patients with low eGFR receiving RRC, adjusted excess AE risk was 13.7%. (95% CI 1.7 to 25.1%). For patients with low eGFR, adjusted odds ratio for RRC failure was 3.07. (95% CI 1.74 to 5.43) CONCLUSIONS: In this cohort of ED AFF patients receiving RRC, those with low eGFR had significantly increased adjusted excess risk of AE compared with patients with normal renal function. Odds of treatment failure were also significantly increased.
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The objective of this study was to examine temporal trends in mental health visits to the emergency department (ED) and to determine differences in length of stay (LOS) between mental health visits and visits for non-mental health conditions. ⋯ The number of mental health visits to the ED is linearly increasing over time, and the LOS in the ED is significantly longer for mental health visits for almost all discharge dispositions. Thus, systematic changes are needed to address the ED capacity to provide care for the growing mental health population.