Management of Atrial Fibrillation in the Emergency Department

Raghavan, Arun; Decker, Wyatt W.; Meloy, Thomas D.

doi:10.1016/j.emc.2005.07.013

Cited by 29 publications

(14 citation statements)

References 32 publications

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“…Consistent with our findings, previous studies have reported observation units as a useful choice for improving the utilization of health care resources [20], especially for successful treatment of chest pain [21], asthma [22], and syncope [23] and eventually for treatment of AF, to reduce in-hospital stay [24]. Another study showed cost savings with the use of oral rate control agents, appropriate anticoagulation, and electrical cardioversion, with expedited referral to an outpatient AF clinic [25].…”

Section: Discussionsupporting

confidence: 76%

Clinical management of atrial fibrillation: early interventions, observation, and structured follow-up reduce hospitalizations

Conti

Canuti

Mariannini

et al. 2012

The American Journal of Emergency Medicine

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Background: Novel facilities such as an intensive observation unit and an outpatient clinic could result in improving management of patients presenting with atrial fibrillation (AF). Methods: This observational study enrolled 3475 patients. Group 1 (1120 patients; years [2004][2005] was managed with standard approach; group 2 (992 patients; years [2006][2007] was managed with additional intensive observation; group 3 (1363 patients; years 2008-2009) was managed with additional intensive observation and outpatient clinic. Primary end point was admission to hospital. Secondary end points included modalities of rhythm conversion and administration of class IC vs class III antiarrhythmic drugs in patients with AF lasting less than 48 hours. Results: Lack of rhythm control, comorbidities, diabetes, and age were independent predictors of hospitalization. Admissions significantly decreased from group 1 (50%) to 2 (38%) and to 3 (24%) (P b .001). Interestingly, more than a quarter of patients in group 3 were referred to the outpatient clinic for short-term follow-up, eventually avoiding admission. Patients with AF lasting less than 48 hours (n = 2189) and without structural heart disease (n = 1685) achieved sinus rhythm in 89% of cases and were discharged. In these patients, early administration of antiarrhythmic drugs of class IC and III gained sinus rhythm in 80% and 20%, respectively (P b .001). Spontaneous conversion occurred in 26%; electrical, 17%; and pharmacological, 57%. Conclusions: In patients with AF, beyond the standard approach, the novel organization with an additional intensive observation unit for early pharmacological interventions and an outpatient clinic for elective treatment and short-term follow-up significantly reduced admission irrespective of independent predictors of hospitalizations. Patients without structural heart disease treated with antiarrhythmic drugs achieved sinus rhythm in 89% of cases, mostly with class IC drugs.

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Section: Discussionsupporting

confidence: 76%

Clinical management of atrial fibrillation: early interventions, observation, and structured follow-up reduce hospitalizations

Conti

Canuti

Mariannini

et al. 2012

The American Journal of Emergency Medicine

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“…9 Although this practice has been shown to be both safe and effective in the short term, we suspect that there is considerable variability in practice between different regions of the world, and to the best of our knowledge, to date there are no published studies exploring this. [10][11][12] The objective of this study was to evaluate ED practice variation in the management of RAF with regard to rate control, rhythm control, procedural sedation, anticoagulation, and patient disposition in four Englishspeaking regions: Canada, the United States, the United Kingdom, and Australasia.…”

mentioning

confidence: 99%

An International View of How Recent‐onset Atrial Fibrillation Is Treated in the Emergency Department

Rogenstein

Kelly

Mason

et al. 2012

Academic Emergency Medicine

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“…Because of its high prevalence in the population, hypertension independently accounts for more AF cases than any other risk factor [18,19]. Several other studies stated Observation Units as a rational choice for improving the utilization of health care resources [20], especially for successful treatment of chest pain [21], asthma [22], syncope [23] and eventually for treatment of AF, in order to reduce in-hospital stay [24]. Nonetheless no strategy to pursue normal sinus rhythm including antiarrhythmic drug therapy, conversion and ablation has definitely being shown to reduce the risk of stroke and hospitalization [25], in our setting physicians were strongly invited to consider pharmacological conversion as first line treatment [9].…”

Section: Discussionmentioning

confidence: 99%

Aggressive approach and outcome in patients presenting atrial fibrillation and hypertension

Conti

Canuti

Mariannini

et al. 2013

International Journal of Cardiology

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Aim: Aggressive approach in patients presenting atrial fibrillation (AF) and hypertension could result in improving rhythm control and reducing admission. Methods: Out of 3475 patients presenting AF, those with hypertension (n = 1739, 52%) underwent standard (n = 591, group 1, years [2004][2005] or aggressive pharmacological and electrical approach (n = 1148, group 2, years 2006-2009). Overall, in 1071 patients AF duration was less than 48 h. Primary endpoint was rhythm conversion; secondary endpoints were modalities of rhythm conversion and reduction of admissions. Results: At univariate and multivariate analyses, AF lasting less than 48 h, absence of comorbidities and younger age were independent predictors of sinus rhythm; conversely, lack of sinus rhythm, older age, AF lasting more than 48 h and comorbidities were independent predictors of hospitalization. Overall, 55% of patients achieved sinus rhythm in group 1 versus 62% in group 2 (p=0.018). Interestingly, in patients with AF lasting less than 48 h, 89% achieved sinus rhythm, more likely by class 1C than by class III antiarrhythmic drugs (pb 0.001). Overall reduction of admission accounts for 60%; 50% of patients need admission in group 1 versus 29% in group 2 (pb 0.001). Conclusions: Aggressive pharmacological and electrical approach in patients presenting AF and hypertension significantly improved rhythm conversion overall up to 62%. Patients with AF lasting less than 48 h eventually achieved sinus rhythm up to 89%, mostly by class IC antiarrhythmic drugs. Admissions eventually reduced up to 60%.

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Management of Atrial Fibrillation in the Emergency Department

Cited by 29 publications

References 32 publications

Clinical management of atrial fibrillation: early interventions, observation, and structured follow-up reduce hospitalizations

Clinical management of atrial fibrillation: early interventions, observation, and structured follow-up reduce hospitalizations

An International View of How Recent‐onset Atrial Fibrillation Is Treated in the Emergency Department

Aggressive approach and outcome in patients presenting atrial fibrillation and hypertension

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