Emergency Department Patients With Atrial Fibrillation or Flutter and an Acute Underlying Medical Illness May Not Benefit From Attempts to Control Rate or Rhythm

Scheuermeyer, Frank; Pourvali, Reza; Rowe, Brian H.; Grafstein, Eric; Heslop, Claire; MacPhee, Jan; McGrath, Lorraine; Ward, John; Heilbron, Brett; Christenson, Jim

doi:10.1016/j.annemergmed.2014.09.012

Cited by 37 publications

(32 citation statements)

References 33 publications

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“…The two groups had similar proportions of primary AFF, as well as many of the acute underlying illnesses (secondary AFF), but women appeared to have increased risk of sepsis. This is relevant since patients with AFF and sepsis appear to have poor 30-day outcomes; in addition, these patients also respond poorly to rate or rhythm control attempts at in the ED, 16 making early identification a priority. Surprisingly, and contrary to prior findings in non-ED-based studies, there appeared to be no ED care disparities between sexes, although the small numbers require mention.…”

Section: Discussionmentioning

confidence: 99%

“…Since the former group of patients appears to have better 30-day outcomes, fewer ED-based adverse events, and greater success with rate or rhythm control, 16 the latter group was identified according to previously outlined methods 8,16 (Data Supplement S1, available as supporting information in the online version of this paper). To summarize, two blinded reviewers examined all patient charts and determined if each patient had an acute underlying illness according to prespecified criteria and, if so, made a diagnosis, also based on those criteria.…”

Section: Study Protocolmentioning

confidence: 99%

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There Are Sex Differences in the Demographics and Risk Profiles of Emergency Department (ED) Patients With Atrial Fibrillation and Flutter, but no Apparent Differences in ED Management or Outcomes

Scheuermeyer

Mackay

Christenson

et al. 2015

Academic Emergency Medicine

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Objectives: In non-emergency department (ED) settings, women with atrial fibrillation and flutter (AFF) have different presentations, treatments, and outcomes than men: they are older, less likely to be treated with rhythm control strategies or appropriate anticoagulation, and more likely to have strokes. This has not been investigated in ED patients. Methods:Records from consecutive ED patients from January 1 to December 31, 2009, with electrocardiogram-proven AFF at two urban hospitals were collected. Review of administrative and clinical data identified patient demographics, clinical characteristics, comorbidities, and ED treatments. The regional ED database was queried to determine 30-day and 1-year follow-up visits, and the provincial vital statistics database was referenced to obtain 30-day and 1-year mortality; all outcomes were stratified by sex. The primary outcome, which reflected overall appropriateness of ED care, was the proportion of patients who were discharged home at their index ED visits, who then had unscheduled 30-day ED revisits. Secondary outcomes included the proportion of eligible patients who underwent acute rhythm control strategies and the proportion of high-risk patients who had previously inadequately anticoagulation strategies corrected by the emergency physician. Additional outcomes included the ED length of stay (LOS) and 30-day and 1-year rates of stroke and death.Results: A total of 1,112 records were reviewed: 470 women (42.3%) and 642 men. Women were a median 8 years (interquartile range = 3 to 13 years) older than men, had higher rates of cardiovascular comorbidities, and were more likely to present with atypical symptoms such as weakness or dyspnea. On their index ED visits, 50.2% of women and 41.3% of men were admitted. At 30 days, 39 of 234 (16.7%) women and 55 of 377 (14.6%) men who were discharged at their index ED visits had made revisits, for a risk difference of 2.1% (95% confidence interval = -3.9% to 8.5%). There were no apparent sex differences in the use of acute rhythm control or in the appropriateness of anticoagulation decisions. ED LOS was similar between women and men, as were 30-day and 1-year stroke or death rates. Conclusions:Female ED AFF patients were older, had more comorbidities, and were more likely to be admitted. However, the overall management and outcomes, including 30-day revisits, appeared to be

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Section: Discussionmentioning

confidence: 99%

Section: Study Protocolmentioning

confidence: 99%

There Are Sex Differences in the Demographics and Risk Profiles of Emergency Department (ED) Patients With Atrial Fibrillation and Flutter, but no Apparent Differences in ED Management or Outcomes

Scheuermeyer

Mackay

Christenson

et al. 2015

Academic Emergency Medicine

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“…6 Unfortunately, patients with such underlying conditions, typically elderly patients or those with substantial comorbidities, are unlikely to benefit from such therapies and are more likely to experience adverse events than success. 10 Instead, the CAEP/CANet guidelines recommend identification of such patients and then the management of the acute underlying issue. As such patients may comprise up to one-third of all ED patients with AFF, 10 rapid selection and appropriate therapy is paramount.…”

Section: -9mentioning

confidence: 99%

“…10 Instead, the CAEP/CANet guidelines recommend identification of such patients and then the management of the acute underlying issue. As such patients may comprise up to one-third of all ED patients with AFF, 10 rapid selection and appropriate therapy is paramount. 6 Second, while traditional guidelines have equivocated between rate and rhythm control for ED patients with AFF at low risk of stroke, the new guidelines promulgate a rhythm-first approach to achieve a normal sinus rhythm and to prevent unnecessary admissions quickly.…”

Section: -9mentioning

confidence: 99%

New frontiers in Canadian atrial fibrillation management

Scheuermeyer

2018

CJEM

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“…This reinforces the idea of investigating the secondary cause before adopting complementary measures in the initial approach, unless the patient presents with hemodynamic instability. 6 3) Obtain proper control of HR There are two main strategies for managing the symptoms of patients with AF: control of HR using AV node blockers, or rhythm control (reversion to sinus rhythm followed by maintenance), either with antiarrhythmic drugs or by catheter ablation.…”

Section: -3mentioning

confidence: 99%

Atrial fibrillation with high ventricular rate in emergency room: What’s the best strategy for treatment?

Soeiro

Leal

Soeiro

et al. 2016

Rev. Assoc. Med. Bras.

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Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and can lead to significant decline in functional status and quality of life among affected patients. The risk of developing AF increases with age and the presence of structural heart disease. Thus, the attendance of patients with high ventricular response to AF is common, which makes knowledge of its management mandatory. In this context, the choice of heart rate and/or rhythm control therapy is fundamental and complex, with multiple possibilities. Thus, this review aims to assist in the management of these patients, systematizing their care.

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Emergency Department Patients With Atrial Fibrillation or Flutter and an Acute Underlying Medical Illness May Not Benefit From Attempts to Control Rate or Rhythm

Cited by 37 publications

References 33 publications

There Are Sex Differences in the Demographics and Risk Profiles of Emergency Department (ED) Patients With Atrial Fibrillation and Flutter, but no Apparent Differences in ED Management or Outcomes

There Are Sex Differences in the Demographics and Risk Profiles of Emergency Department (ED) Patients With Atrial Fibrillation and Flutter, but no Apparent Differences in ED Management or Outcomes

New frontiers in Canadian atrial fibrillation management

Atrial fibrillation with high ventricular rate in emergency room: What’s the best strategy for treatment?

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