Public versus private hospital pathways after emergency medical services transport for atrial fibrillation: a population-based cohort study

doi:10.1136/heartjnl-2026-328067

Arrhythmias & electrophysiologyCohort study

Public versus private hospital pathways after emergency medical services transport for atrial fibrillation: a population-based cohort study

HeartPublished 18 Jun 2026

Population-based cohort study
linked ambulance, emergency department, hospital admission and mortality data
multilevel-adjusted regression models

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Authors' conclusion

In a universal healthcare system, hospital sector after EMS transport for AF was associated with substantial differences in procedural care and recurrent ambulance utilisation. These findings highlight sector-based variation in access to rhythm-control interventions and postdischarge pathways.

Study context

Population: Adult emergency medical services (EMS) attendances for atrial fibrillation (AF) with successful linkage in Victoria, Australia (January 2015 to June 2019)EMS attendances for AF, 14,526 (88%) transported to public hospitals
Participants: 16,415 attendances

Exposure: public versus private hospitals
Public hospitalsn = 14,526

Main finding

As reported in the abstract

Age

Public hospitals78median · years

Private hospitals73median · years

Observational data: associations, not effects.

Further findings

Most disadvantaged socioeconomic quintile

Public hospitals24.5%

Private hospitals11.5%

Age-standardised incidence of EMS-transported AF

Public hospitals121 per 100 000 person-years

Private hospitals14 per 100 000 person-years

Outcome	Lower with public hospitals ←→ Higher with public hospitals	Estimate
Invasive cardiac procedures · index admission · coronary angiography		aOR 0.29 (95% CI 0.23–0.36)
Invasive cardiac procedures · index admission · catheter ablation		aOR 0.08 (95% CI 0.04–0.18)
Invasive cardiac procedures · index admission · cardioversion		aOR 0.47 (95% CI 0.36–0.63)
EMS reattendance · within 30 days		aHR 1.56 (95% CI 1.09–2.24)
Long-term mortality · median follow-up of 1.57 years (IQR 0.67 to 2.93)		aHR 0.80 (95% CI 0.72–0.88)
	0.050.21520Ratio (log scale)

Invasive cardiac procedures · index admission

disparities persisted during follow-up

Original publication

Public versus private hospital pathways after emergency medical services transport for atrial fibrillation: a population-based cohort study. Heart. Published 18 June 2026. doi:10.1136/heartjnl-2026-328067

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Summarised from the published abstract; every number is checked against it