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April 10, 2026BMC Emergency MedicineOpen Access

Afternoon emergency department presentation independently increased the risk of atrial fibrillation or flutter ECG overinterpretation compared to morning shifts (OR 1.87).

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Why the study?

Does the timing of emergency department presentation affect the diagnostic accuracy of ECG interpretation for atrial fibrillation or flutter?

Population

2,003 consecutive patients discharged from the emergency department with a diagnosis of AF or AFL over five…

Comparison

Emergency department presentation during… vs Comparison between morning, afternoon, and night…

Design

Cohort, ECGs were independently reviewed by two cardiologists

Key result

Afternoon emergency department presentation independently increased the risk of atrial fibrillation or flutter ECG overinterpretation compared to morning shifts (OR 1.87).

Authors

YAYuval AvidanBWBaruch WeizmanSZSameha Zahra

Discussion

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Overview

ECG overinterpretation of atrial fibrillation or flutter in the emergency department is most frequent during afternoon shifts and leads to significant inappropriate prescribing of anticoagulants and antiarrhythmics, resulting in bleeding complications.

Key Points

  • This study aims to identify the determinants contributing to the misdiagnosis of atrial fibrillation and flutter in the emergency department setting.
  • Reviewed ECGs of patients with AF or AFL over five years by two cardiologists.
  • Classified ECG interpretations as correct, partially correct, or overinterpreted.
  • Grouped patient arrival times into morning, afternoon, and night shifts.
  • Applied multivariable logistic regression to identify predictors of overinterpretation.
  • Out of 2,003 patients, 88.9% had correct ECG interpretations, while 8.3% were partially correct and 2.8% overinterpreted.
  • Overinterpretation rates were highest in the afternoon (4.3%) compared to morning (2.8%) and night (0.7%).
  • Independent predictors of overinterpretation included afternoon arrival and premature beats, with significant odds ratios.
  • Inappropriate prescriptions were made in 38.5% cases, leading to bleeding complications in 16% of cases.

Study Design

Type

Observational (n=2,003)

Multicenter

No

Structured PICO

Does the timing of emergency department presentation affect the diagnostic accuracy of ECG interpretation for atrial fibrillation or flutter?

P
Population
2,003 consecutive patients (1,794 with atrial fibrillation; 209 with atrial flutter) discharged from the emergency department with a diagnosis of AF or AFL over five years (2019–2024).
I
Intervention
Emergency department presentation during different shifts (morning 07:00–15:00, afternoon 15:00–23:00, and night 23:00–07:00).
C
Comparator
Comparison between morning, afternoon, and night shifts.
O
Outcome
Diagnostic accuracy of ECG interpretation (classified as correct, partially correct, or overinterpreted).

Main Result

Effect estimate: OR 1.87 (95% CI 1.07-3.25)

Absolute Event Rate: 4.3% vs 2.8%

p-value: p=0.027

ECG overinterpretation of atrial fibrillation or flutter in the emergency department is most frequent during afternoon shifts and leads to significant inappropriate prescribing of anticoagulants and antiarrhythmics, resulting in bleeding complications.

Limitations

  • Retrospective, single-center design
  • Lack of systematic data on referral patterns
  • Inability to determine average completion time for ECG review

Cite This Study

Avidan et al. (2026) conducted an observational in Atrial fibrillation or atrial flutter (n=2,003). Afternoon shift presentation vs. Morning shift presentation was evaluated on ECG overinterpretation of atrial fibrillation or flutter (OR 1.87, 95% CI 1.07-3.25, p=0.027). Afternoon emergency department presentation independently increased the risk of atrial fibrillation or flutter ECG overinterpretation compared to morning shifts (OR 1.87).

synapsesocial.com/papers/69d893626c1944d70ce04675https://doi.org/10.1186/s12873-026-01574-z
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Diagnostic accuracy of an AI-based ECG algorithm for atrial flutter: a prospective comparison with electrophysiological study2026
  2. 2An aggressive electrophysiologist-guided rhythm control strategy significantly reduces hospital admissions in patients presenting with atrial fibrillation in the emergency department2026
  3. 3Current management of atrial fibrillation in the emergency department2025
  4. 4Beyond atrial fibrillation screening: characterizing other clinically relevant arrhythmias detected during 14-day electrocardiogram monitoring2026
  5. 5Frequency, causes and predictors for cancellation of elective electrical cardioversion of atrial fibrillation and flutter2026