Grant: Project Grant

Atrial fibrillation (AF) is an abnormal heart rhythm that, untreated, can lead to a stroke and/or heart failure. With the aging of the population, the number of people with AF is expected to increase dramatically: 250% by the year 2050. ER visits for AF already increased by 88% between 1996 and 2004. In Ontario we admit 40% of these ER patients to hospital. However if the number of ER AF patients increases by 250%, the healthcare system is likely to begin to fail if we continue to admit the same percentage of this much larger pool of patients to hospital. Most patients can receive the care they need at office visits; most tests and therapies don't require a hospital stay. They have very few bad outcomes (e.g. stroke, death) after their ER visit: in context with the high (40%) admission rate, there appears to be an opportunity to safely send more of these patients home from the ER, IF the high-risk patients can be reliably identified in the ER (so that they receive the in-hospital care they need to avoid bad outcomes). We have created tools to help ER physicians to identify these patients. The tools perform well so far, but this needs to be confirmed in another group of patients, in order to be scientifically rigorous and safe. Our project objective is to perform the final test of the tools. We will enroll AF patients from 11 ERs, where ER physicians will enter the components of the tools (e.g. patient age, lab results, etc.) into a password-protected website. The data will be sent securely to our research institute for analysis, where we have records of all deaths, hospitalizations, and ER visits in Ontario. If the tools prove successful they will safely allow more people with AF to go home, will reduce subsequent deaths, and will identify predictors of return ER visits. These tools could safely reduce the number of patients who are being hospitalized by up to half, which would in turn preserve the safety of the hospital system for patients who need it most.