scholarly journals 189. Validating a Hospitalist-Specific Antibiotic Prescribing Metric across Four Acute Care Hospitals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S100-S101
Author(s):  
Jessica Howard-Anderson ◽  
Cara Nys ◽  
Julianne N Kubes ◽  
William C Dube ◽  
Benjamin Albrecht ◽  
...  
Keyword(s):  
Research Training ◽  
Antibiotic Use ◽  
Primary Diagnosis ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Antibiotic Administration ◽  
Obstructive Pulmonary Disease ◽  
Leadership Group ◽  
Immunocompromised Status ◽  
Hospital Stays

Abstract Background Peer comparison reduces unnecessary outpatient antibiotic prescribing, but no prescribing metric has been validated for inpatient comparison. We aimed to evaluate if an electronically derived antibiotic prescribing metric correlated with indicated antibiotic days in hospitalized patients. Methods We previously created a hospitalist-specific adjusted antibiotic use metric (observed:expected [O:E]) for National Healthcare Safety Network-defined broad-spectrum antibiotics. From May-Oct 2019 at four Emory Healthcare hospitals, we identified outlier hospitalists prescribing in the top (high O:E) and bottom (low O:E) 15th percentile. We randomly selected 10 days of antibiotic administration from each outlier and reviewed days with > 2 days of consecutive days of antibiotics. For pneumonia, chronic obstructive pulmonary disease (COPD), or urinary tract infection (UTI) we determined if each day of antibiotics was indicated, assuming the diagnosis was accurate. We compared high vs. low O:E providers and used regression modeling to determine if the metric predicted indicated days of antibiotics. Results Among 997 days, 510 (51%) were from high and 487 (49%) from low O:E providers. High O:E providers had a greater proportion of days with > 2 prior days of antibiotics (60%) compared to low O:E providers (54%, p = 0.03). In the subset of days with > 2 prior days of antibiotics (n = 569), high O:E providers had more patient-days with longer hospital stays, diabetes and Charlson comorbidity index (CCI) >3, and fewer days supervising (resident/advanced practice provider, Table 1). The primary diagnosis was pneumonia, COPD exacerbation or UTI in 260 (25%) days; 91% were indicated based on duration with no difference between high and low O:E providers (88% vs. 94%, p = 0.1). After controlling for days of hospitalization, CCI, immunocompromised status, and supervisory role, a high O:E was not associated with indicated antibiotic use (OR 0.5, 95% CI 0.2 – 1.3). Description of days with a patient on greater than two days of antibiotics, comparing high- versus low-metric providers Conclusion A high hospitalist antibiotic prescribing metric correlated with patients receiving > 2 consecutive days of antibiotics on any given day but did not predict unindicated antibiotic use for a subset of diagnoses. Evaluating indicated use by validating diagnoses may improve metric performance. Disclosures Jessica Howard-Anderson, MD, Antibacterial Resistance Leadership Group (ARLG) (Other Financial or Material Support, The ARLG fellowship provides salary support for ID fellowship and mentored research training)

scholarly journals 1992. Initial Procalcitonin Level and Antibiotic Practice Patterns Among Patients with Acute Respiratory Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S668-S668
Author(s):  
Jessica K Costales ◽  
Jim H Nomura ◽  
Wen-Ling Joanie. Chung ◽  
Kristen Ironside ◽  
John J Sim ◽  
...  
Keyword(s):  
Health System ◽  
Real World ◽  
Practice Patterns ◽  
Respiratory Infections ◽  
Antibiotic Use ◽  
Primary Diagnosis ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Prescribing Practices

Abstract Background The utility of procalcitonin (PCT)-guided algorithms to decrease antibiotic use has been extensively studied in clinical trials. The guidance that PCT provides as it translates into real-world practice is unclear. This study aims to describe real-world antibiotic prescribing practices in relation to PCT in patients admitted to our US-based health system with acute respiratory infections. Methods Retrospective cohort study of 1,606 adults admitted within our US health system from January 1, 2016 to December 31, 2018 with a primary diagnosis of acute upper or lower respiratory infection with at least one PCT measurement. Antibiotic practice patterns were evaluated using pharmacy analytic information and antibiotic status to note antibiotics given prior to and 36 hours after PCT result. Analysis of discordance with initial PCT level was defined as continuing or starting antibiotics after a low PCT level (PCT ≤0.25 μg/L) and withholding or discontinuing antibiotics after a high PCT level (PCT > 0.25 μg/L). Results Antibiotic prescription patterns after the result of initial PCT level are summarized in Table 1. Only 242 patients (15%) had more than one PCT-level checked. Overall, antibiotic discordance with initial PCT result was 45%; mostly attributed to continuing or starting antibiotics despite a low PCT level (77%). (Figure 1) There were 496 patients who were initially started and continued on antibiotics despite a low PCT result. Of this subgroup, only one patient had a serial PCT measured, and 12 were admitted for Chronic Obstructive Pulmonary Disease (COPD) exacerbation and continued on azithromycin/doxycycline after result of the low PCT. Conclusion Utilization of antibiotics went against well-studied PCT cutoffs 45% of the time, primarily driven by antibiotic use at low PCT levels. Only a small number were continued on azithromycin/doxycycline for anti-inflammatory effect in COPD exacerbations, indicating that most patients received antibiotics for presumed bacterial infection despite the high negative predictive value of PCT. This study illustrates PCT use in real-world practice did not significantly alter prescribing practices, potentially from lack of confidence or knowledge in interpreting PCT results and lack of serial measurements to aid in decision-making. Disclosures All authors: No reported disclosures.

scholarly journals Real-world antibiotic use in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in China: Evidence from the ACURE study

2021 ◽  
Vol 12 ◽  
Author(s):  
Yiming Ma ◽  
Ke Huang ◽  
Chen Liang ◽  
Xihua Mao ◽  
Yaowen Zhang ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Real World ◽  
Antibiotic Use ◽  
Tertiary Hospital ◽  
Chronic Obstructive ◽  
Oral Antibiotics ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbations ◽  
Hospital Group

Background: The evidence for real-world antibiotic use in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is insufficient. This study aimed to investigate real-world antibiotic use in the management of AECOPD in China.Methods: All hospitalized AECOPD patients from the acute exacerbation of chronic obstructive pulmonary disease inpatient registry (ACURE) study conducted at 163 sites between January 2018 and December 2019 were screened according to the eligible criteria. The eligible study population was divided into secondary and tertiary hospital groups. Patients’ baseline characteristics, antibiotic use, and bacterial pathogen characteristics were retrieved and analyzed using SPSS 23.0.Results: A total of 1663 patients were included in the study, including 194 patients from secondary hospitals and 1469 patients from tertiary hospitals. Among the 1663 AECOPD patients enrolled, 1434 (86.2%) received antibiotic treatment, comprising approximately 85.6% and 86.3% of patients in the secondary and tertiary hospital groups, respectively. The median antibiotic therapy duration was 9.0 (interquartile range [IQR]: 7.0 - 11.0)°days. Regarding the routes of antibiotic use, 1400 (97.6%) patients received intravenous antibiotics, 18 (1.3%) patients received oral antibiotics, 15 (1.0%) patients received both intravenous and oral antibiotics, and one (0.1%) patient received both oral and nebulized antibiotic treatment. In addition, cephalosporin, penicillin, and quinolone were the most commonly prescribed antibiotics (43.6%, 37.0%, and 34.2%, respectively). In total, 990 (56.5%) patients underwent pathogen examinations; the proportion of patients receiving pathogen examinations in the second hospital group was significantly lower than that in the tertiary hospital group (46.4% vs 61.3%, p < 0.001).Conclusion: This study demonstrates that an antibiotic overuse may exist in the treatment of AECOPD in China. Measures should be taken to prevent the overuse of antibiotics and potential antimicrobial resistance (AMR) in Chinese AECOPD patients.

Antibiotic Prescribing Patterns in Italian Hospital Inpatients with Pneumonia, Chronic Obstructive Pulmonary Disease, and Urinary Tract Infections

1993 ◽  
Vol 27 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Luigi Guglielmo ◽  
Roberto Leone ◽  
Ugo Moretti ◽  
Anita Conforti ◽  
Alvise Spolaor ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Obstructive Pulmonary Disease ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Prescribing Patterns ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Obstructive Pulmonary Disease ◽  
Tract Infections ◽  
Hospital Inpatients

OBJECTIVE: The primary objective of this study was to describe the antibiotic prescribing patterns in hospital inpatients with pneumonia (PN), exacerbations of chronic obstructive pulmonary disease (COPD), and urinary tract infections (UTIs). A second objective was to verify if some selected variables (i.e., risk factors, patient age, size of hospitals) were affecting the therapeutic choice. DESIGN: Survey was performed on 1609 patients. The data were collected by physicians using a special form, covering a six-month period. SETTING: Twenty-six medical wards and 8 geriatric wards in 24 acute-care hospitals in the Veneto Region in Northern Italy. PATIENTS: A consecutive sample of PN, COPD, and UTI patients treated with antibiotics. MAIN OUTCOME MEASURES: The following information was collected: patient and hospital demographics, risk factors, diagnoses, and antibiotic regimens. RESULTS: Sixty-three antimicrobial agents used, with 2115 administrations, 1227 of which were single-drug therapy. The most frequently used drugs were third-generation cephalosporins (24.6 percent), fluoroquinolones (15.4 percent), aminopenicillins (15.0 percent), and ureidopenicillins (9.7 percent). There is great variability of therapeutic regimens in the various hospitals for the same disease. However, this variability is not explained by the different types of hospitals or by the patients' characteristics (e.g., age, risk factors). CONCLUSIONS: Our results show that the use of broad-spectrum antibiotics probably is excessive. Moreover, the treatment seems to be based more on the opinion of the treating physician and the local habits rather than objective criteria. These factors may have negative repercussions not only in economic terms, but also in terms of alteration of the bacterial ecology.

scholarly journals Clinical Significance of Procalcitonin, C-Reactive Protein, and Interleukin-6 in Helping Guide the Antibiotic Use for Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Wen Song ◽  
Yue Wang ◽  
Fengming Tian ◽  
Liang Ge ◽  
Xiaoqian Shang ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Interleukin 6 ◽  
Antibiotic Use ◽  
Diagnostic Value ◽  
Chronic Obstructive ◽  
C Reactive Protein ◽  
Obstructive Pulmonary Disease ◽  
Reactive Protein ◽  
Acute Exacerbations ◽  
Antibiotic Group

Background. Currently, standards of antibiotic use in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients are controversial. Objective. The aim of the present study was to analyze the value of procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6) levels to guide the antibiotic treatment of AECOPD patients. Methods. A total of 371 patients with COPD or AECOPD were included in the study. Clinical and laboratory data were obtained at admission, 325 AECOPD patients and 46 sCOPD patients treated with antibiotics. The receiver operating curve (ROC) was used to evaluate the relationship between CRP, PCT, and IL-6. Results. This study included medical record/case control 1, the COPD group ( n = 46 ) and the AECOPD group ( n = 325 ), and medical record control 2, the nonchanged antibiotic group ( n = 203 ) and the changed antibiotic group ( n = 61 ). In case 1, CRP, PCT, and IL-6 levels in the AECOPD group were higher than that in the control group ( P < 0.05 ), while the result of ROC showed that IL-6 had higher AUC values (0.773) and higher sensitivity (71.7%) than other indicators. The specificity of PCT (93.5%) is higher than other indicators. In case 2, ROC curve results showed that the AUC value of IL-6 (0.771) was slightly higher than PCT and CRP. The sensitivity (85.2%) and specificity (65.5%) of CRP were higher than other indicators. Conclusions. IL-6 and PCT were elevated in AECOPD patients, resulting in a higher diagnostic value for AECOPD. CRP had a higher diagnostic value for antibiotic use in AECOPD patients.

scholarly journals C-reactive protein point-of-care testing for safely reducing antibiotics for acute exacerbations of chronic obstructive pulmonary disease: the PACE RCT

2020 ◽  
Vol 24 (15) ◽  
pp. 1-108 ◽  
Author(s):  
Nick A Francis ◽  
David Gillespie ◽  
Patrick White ◽  
Janine Bates ◽  
Rachel Lowe ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Health Status ◽  
Usual Care ◽  
Pulmonary Disease ◽  
Antibiotic Consumption ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Diagnostic Strategy ◽  
Obstructive Pulmonary Disease ◽  
Patient Reported

Background Most patients presenting with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in primary care are prescribed antibiotics, but these may not be beneficial, and they can cause side effects and increase the risk of subsequent resistant infections. Point-of-care tests (POCTs) could safely reduce inappropriate antibiotic prescribing and antimicrobial resistance. Objective To determine whether or not the use of a C-reactive protein (CRP) POCT to guide prescribing decisions for AECOPD reduces antibiotic consumption without having a negative impact on chronic obstructive pulmonary disease (COPD) health status and is cost-effective. Design A multicentre, parallel-arm, randomised controlled open trial with an embedded process, and a health economic evaluation. Setting General practices in Wales and England. A UK NHS perspective was used for the economic analysis. Participants Adults (aged ≥ 40 years) with a primary care diagnosis of COPD, presenting with an AECOPD (with at least one of increased dyspnoea, increased sputum volume and increased sputum purulence) of between 24 hours’ and 21 days’ duration. Intervention CRP POCTs to guide antibiotic prescribing decisions for AECOPD, compared with usual care (no CRP POCT), using remote online randomisation. Main outcome measures Patient-reported antibiotic consumption for AECOPD within 4 weeks post randomisation and COPD health status as measured with the Clinical COPD Questionnaire (CCQ) at 2 weeks. For the economic evaluation, patient-reported resource use and the EuroQol-5 Dimensions were included. Results In total, 653 participants were randomised from 86 general practices. Three withdrew consent and one was randomised in error, leaving 324 participants in the usual-care arm and 325 participants in the CRP POCT arm. Antibiotics were consumed for AECOPD by 212 out of 274 participants (77.4%) and 150 out of 263 participants (57.0%) in the usual-care and CRP POCT arm, respectively [adjusted odds ratio 0.31, 95% confidence interval (CI) 0.20 to 0.47]. The CCQ analysis comprised 282 and 281 participants in the usual-care and CRP POCT arms, respectively, and the adjusted mean CCQ score difference at 2 weeks was 0.19 points (two-sided 90% CI –0.33 to –0.05 points). The upper limit of the CI did not contain the prespecified non-inferiority margin of 0.3. The total cost from a NHS perspective at 4 weeks was £17.59 per patient higher in the CRP POCT arm (95% CI –£34.80 to £69.98; p = 0.408). The mean incremental cost-effectiveness ratios were £222 per 1% reduction in antibiotic consumption compared with usual care at 4 weeks and £15,251 per quality-adjusted life-year gained at 6 months with no significant changes in sensitivity analyses. Patients and clinicians were generally supportive of including CRP POCT in the assessment of AECOPD. Conclusions A CRP POCT diagnostic strategy achieved meaningful reductions in patient-reported antibiotic consumption without impairing COPD health status or increasing costs. There were no associated harms and both patients and clinicians valued the diagnostic strategy. Future work Implementation studies that also build on our qualitative findings could help determine the effect of this intervention over the longer term. Trial registration Current Controlled Trials ISRCTN24346473. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 15. See the NIHR Journals Library website for further project information.

scholarly journals Patterns of Oral Antibiotic Use and Excess Duration at Hospital Discharge

2020 ◽  
Vol 41 (S1) ◽  
pp. s522-s523
Author(s):  
Corey Medler ◽  
Nicholas Mercuro ◽  
Helina Misikir ◽  
Nancy MacDonald ◽  
Melinda Neuhauser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Guideline Recommendation ◽  
Resistant Organism ◽  
Chronic Obstructive ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Cross Sectional ◽  
Tract Infections

Background: Antimicrobial stewardship (AMS) interventions have predominantly involved inpatient antimicrobial therapy. However, for many hospitalized patients, most antibiotic use occurs after discharge, and unnecessarily prolonged courses of therapy are common. Patient transition from hospitalization to discharge represents an important opportunity for AMS intervention. We describe patterns of antibiotic use selection and duration of therapy (DOT) for common infections including discharge antibiotics. Methods: This retrospective cross-sectional analysis was derived from an IRB-approved, multihospital, quasi-experiment at a 5-hospital health system in southeastern Michigan. The study population included patients discharged from an inpatient general and specialty practice ward on oral antibiotics from November 2018 through April 2019. Patients were included with the following diagnoses: skin and soft-tissue infections (SSTIs), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), respiratory viral infections, acute exacerbation of chronic obstructive pulmonary disease (AECOPD), intra-abdominal infections (IAIs), and urinary tract infections (UTIs). Other diagnoses were excluded. Data were extracted from medical records including antibiotic indication, selection, and duration, as well as patient characteristics. Results: In total, 1,574 patients were screened and 800 patients were eligible for inclusion. The most common antibiotic indications were respiratory tract infections, with 487 (60.9%) patients. These included 165 AECOPD cases (20.6%) and 200 CAP cases (25%) with no multidrug resistant organism (MDRO) risk factors; 57 patients (7.1%) with MDRO risk factors; HAP in 7 patients (0.9%); and influenza in 58 patients (7.2%). Also, 205 (25.6%) patients were diagnosed with UTIs: 71 with cystitis (8.9%), 86 (10.8%) with complicated UTI (cUTI), and 48 (6%) with pyelonephritis. Furthermore, 125 patients (15.6%) were diagnosed with SSTI: 59 (7.4%) purulent and 66 (8.3%) nonpurulent. 31 (3.9%) patients had an IAI. The most commonly used antibiotics were cephalosporins in 536 patients (67%), azithromycin in 252 patients (31.5%), and fluroquinolones and tetracyclines in 231 patients (28.9%). Fluroquinolones were the most frequent antibiotic prescribed at discharge in 210 patients (26.3%). Figure 1 displays the average DOT relative to specific indications. The median duration of total antibiotic therapy exceeded institutional guideline recommendation for multiple conditions, including AECOPD (7 days vs recommended 5 days), CAP with COPD (8.3 vs 7 days ), CAP without COPD (7.7 vs 5 days), and pyelonephritis (11 vs 7–10 days). Also, 269 (33.6%) patients received unnecessary therapy; 218 (27.3%) of these were due to excess duration. Conclusions: Among a cross-section of hospitalized patients, the average DOT, including after discharge, exceeded the optimal therapy for many patients. Further understanding of patterns and influences of antibiotic prescribing is necessary to design effective AMS interventions for improvement.Funding: This work was completed under CDC contract number 200-2018-02928.Disclosures: None

Pressure-Controlled Mechanical Ventilation Is More Advantageous in the Follow-up of Patients with Chronic Obstructive Pulmonary Disease after Open Heart Surgery

2014 ◽  
Vol 17 (1) ◽  
pp. 1
Author(s):  
Murat Ugurlucan ◽  
Murat Basaran ◽  
Filiz Erdim ◽  
Ozer Selimoglu ◽  
Ilker Murat Caglar ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Chronic Obstructive ◽  
Open Heart ◽  
Obstructive Pulmonary Disease ◽  
Controlled Ventilation ◽  
Hospital Stays ◽  
Pressure Controlled

<p><b>Objective:</b> Cardiopulmonary bypass deteriorates pulmonary functions to a certain extent. Patients with chronic obstructive pulmonary disease (COPD) are associated with increased mortality and morbidity risks in the postoperative period of open-heart surgery. In this study we compared 2 different mechanical ventilation modes, pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV), in this particular patient population.</p><p><b>Patients and Methods:</b> Forty patients with severe COPD were assigned to 1 of 2 groups and enrolled to receive PCV or VCV in the postoperative period. Arterial blood gases, respiratory parameters, and intensive care unit and hospital stays were compared between the 2 groups.</p><p><b>Results:</b> Maximum airway pressure was higher in the VCV group. Pulmonary compliance was lower in the VCV group and minute ventilation was significantly lower in the group ventilated with PCV mode. The respiratory index was increased in the PCV group compared with the VCV group and with preoperative findings. Duration of mechanical ventilation was significantly shorter with PCV; however, intensive care unit and hospital stays did not differ.</p><p><b>Conclusion:</b> There is not a single widely accepted and established mode of ventilation for patients with COPD undergoing open-heart surgery. Our modest experience indicated promising results with PCV mode; however, further studies are warranted.</p>

Abstract 13621: Predictors of Short-term and Long-term Clinical Outcomes After an Acute Atrial Fibrillation or Flutter Admission

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jia Yi Anna Ne ◽  
Tu Nguyen ◽  
Stuart Thomas ◽  
Joanne Han ◽  
Emma Charlston ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Primary Diagnosis ◽  
Chronic Obstructive ◽  
Post Discharge ◽  
Obstructive Pulmonary Disease ◽  
Mortality And Morbidity ◽  
Westmead Hospital

Introduction: Atrial fibrillation (AF) is a major cause of mortality and morbidity globally. This study aims to identify predictors of AF-related rehospitalization following an acute AF/flutter admission. Methods: Patients admitted to Westmead Hospital with a primary diagnosis of AF/flutter from 1 May 2014 to 31 May 2018 were included and followed up until 31 May 2019. We defined AF-related rehospitalization as an admission due to recurrent AF/flutter, congestive heart failure, stroke and/or myocardial infarction. Multivariable logistic regression was used to identify independent predictors of 30-day outcomes. Cox regression was used to identify independent predictors of long-term outcomes: first AF-related rehospitalization or all-cause mortality. Results: Of 1664 consecutive patients admitted with AF/flutter, 55.8% were male and the median age was 68.0. At 30 days, 123 (7.4%) had an AF-related readmission (110 for AF/flutter and 13 for other cardiovascular outcomes). During a mean follow-up period of 2.1 ± 1.5 years, 683 (41.0%) of patients had at least one AF-related rehospitalization (38.1%, n=634) or died (2.9%, n=49). Chronic kidney disease (CKD) (OR 1.94, 95% CI 1.07 - 3.50) was an independent predictor of 30-day AF-related rehospitalization. Age (HR 1.01, 95% CI 1.01 - 1.02 for each additional year), initial admission via emergency (HR 1.29, 95% CI 1.08 - 1.54), CKD (HR 1.64, 95% CI 1.24 - 2.18), chronic obstructive pulmonary disease (HR 1.42, 95% CI 1.09 - 1.83) and the presence of additional comorbidities (HR 1.38, 95% CI 1.04 - 1.83) were independent predictors of first AF-related rehospitalization or death (all p <0.05). Conclusion: AF-related rehospitalization is common following an acute AF/flutter admission. AF/flutter patients with comorbidities, particularly renal and pulmonary diseases, are at high risk of readmission. Such patients could be targeted for increased surveillance and additional post-discharge support to prevent readmission.

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