Performance of an expedited rhythm control method for recent onset atrial fibrillation in a community hospital

White, J. Chris; Heller, Michael; Kahoud, Robert J.; Slade, Daniel; Harding, John J.

doi:10.1016/j.ajem.2015.03.059

Cited by 8 publications

(16 citation statements)

References 13 publications

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“…Many ED patients are appropriate for safe and effective outpatient management of AF . AF pathways have been tested in mostly academic settings in the United States and Canada and have met primary safety endpoints.…”

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confidence: 99%

Creation and Implementation of an Outpatient Pathway for Atrial Fibrillation in the Emergency Department Setting: Results of an Expert Panel

Baugh

Clark

Wilson

et al. 2018

Academic Emergency Medicine

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Atrial fibrillation and flutter (AF) is a common condition among emergency department (ED) patients in the United States. Traditionally, ED care for primary complaints related to AF focus on rate control, and patients are often admitted to an inpatient setting for further care. Inpatient care may include further telemetry monitoring and diagnostic testing, rhythm control, a search for identification of AF etiology, and stroke prophylaxis. However, many patients are eligible for safe and effective outpatient management pathways. They are widely used in Canada and other countries but less widely adopted in the United States. In this project, we convened an expert panel to create a practical framework for the process of creating, implementing, and maintaining an outpatient AF pathway for emergency physicians to assess and treat AF patients, safely reduce hospitalization rates, ensure appropriate stroke prophylaxis, and effectively transition patients to longitudinal outpatient treatment settings from the ED and/or observation unit. To support local pathway creation, the panel also reached agreement on a protocol development plan, a sample pathway, consensus recommendations for pathway components, sample pathway metrics, and a structured literature review framework using a modified Delphi technique by a technical expert panel of emergency medicine, cardiology, and other stakeholder groups.

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confidence: 99%

Creation and Implementation of an Outpatient Pathway for Atrial Fibrillation in the Emergency Department Setting: Results of an Expert Panel

Baugh

Clark

Wilson

et al. 2018

Academic Emergency Medicine

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“…Of these, results demonstrated that a significant proportion of ED patients are appropriate for safe and effective outpatient management of AF. [15][16][17] These pathways include strategies for early rhythm control, initiation of rate control therapies and anticoagulation for stroke prophylaxis. 15 16 However, due to barriers in implementation, these strategies have yet to be maintained nor fully accepted.…”

Section: Discussionmentioning

confidence: 99%

Canada-wide mixed methods analysis evaluating the reasons for inappropriate emergency department presentation in patients with a history of atrial fibrillation: the multicentre AF-ED trial

Hong¹,

Babiolakis

Zile

et al. 2020

BMJ Open

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ObjectivesThe primary objective of this study was to ascertain the reasons for emergency department (ED) attendance among patients with a history of atrial fibrillation (AF).DesignAppropriate ED attendance was defined by the requirement for an electrical or chemical cardioversion and/or an attendance resulting in hospitalisation or administration of intravenous medications for ventricular rate control. Quantitative and qualitative responses were recorded and analysed using descriptive statistics and content analysis, respectively. Random effects logistic regression was performed to estimate the OR of inappropriate ED attendance based on clinically relevant patient characteristics.ParticipantsParticipants ≥18 years with a documented history of AF were approached in one of eight centres partaking in the study across Canada (Ontario, Nova Scotia, Alberta and British Columbia).ResultsOf the 356 patients enrolled (67±13, 45% female), the majority (271/356, 76%) had inappropriate reasons for presentation and did not require urgent ED treatment. Approximately 50% of patients(172/356, 48%) were driven to the ED due to symptoms, while the remainder presented on the basis of general fear or anxiety (67/356, 19%) or prior medical advice (117/356, 33%). Random effects logistic regression analysis showed that patients with a history of congestive heart failure were significantly more likely to seek urgent care for appropriate reasons (p=0.03). Likewise, symptom-related concerns for ED presentation were significantly less likely to result in inappropriate visitation (p=0.02). When patients were surveyed on alternatives to ED care, the highest proportion of responses among both groups was in favour of specialised rapid assessment outpatient clinics (186/356, 52%). Qualitative content analysis confirmed these results.ConclusionsImproved education focused on symptom management and alleviating disease-related anxiety as well as the institution of rapid access arrhythmias clinics may reduce the need for unnecessary healthcare utilisation in the ED and subsequent hospitalisation.Trial registration numberNCT03127085

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“…To our knowledge, this is the first systematic review to evaluate the optimal management of AF/AFL in the ED, specifically with regard ED discharge, regardless of the type of acute management that was chosen or rhythm status at time of discharge. It is interesting to note that the articles in the general management group demonstrated a similar rate of short-term adverse events to the articles in the DCCV and chemical cardioversion groups, many of which required patients to convert to NSR in order to be discharged [15,[17][18]20,[25][26][27][28][29][30] . While conversion to NSR seems desirable, particularly in patients with acute onset of AF/AFL, there is no particular reason that persistence of AF/AFL should preclude ED discharge, provided that rate control is adequate and the patient is otherwise stable and not severely symptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…successful conversion rates, respectively [22,23] .The use of IV ibutilide resulted in conversion rates ranging from 64% to 76% [24,25,26,28] . IV procainamide was used by Stiell et al and White et al with a 50% and 67% success rate, respectively [27,30] . Hirschl et al compared a variety of different medications, and found that flecainide (95%) and ibutilide (76%) had the highest rates of conversion to NSR [28] .…”

Section: Electrical Cardioversion-based Protocolsmentioning

confidence: 99%

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Management and Disposition of Atrial Fibrillation in the Emergency Department: A Systematic Review

Vandermolen

Sadaf

Gehi

2018

Journal of Atrial Fibrillation

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Introduction: Management of atrial fibrillation (AF) and atrial flutter (AFL) in the emergency department (ED) varies greatly, and there are currently no United States guidelines to guide management with regard to patient disposition after ED treatment. The aim of this systematic review was to evaluate the literature for decision aids to guide disposition of patients with AF/AFLin the ED, and assess potential outcomes associated with different management strategies in the ED.Methods and Results: A systematic review was done using PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE, combining the search terms "Atrial Fibrillation", "Atrial Flutter", "Emergency Medicine", "Emergency Service", and "Emergency Treatment". After removal of duplicates, 754 articles were identified. After initial screening of titles and abstracts, 69full text articles were carefully reviewed and 34 articles were ultimately included in the study based on inclusion and exclusion criteria. The articles were grouped into four main categories: decision aids and outcome predictors, electrical cardioversion-based protocols, antiarrhythmic-based protocols, and general management protocols.Conclusion: This systematic review is the first study to our knowledge to evaluate the optimal management of symptomatic AF/AFLin the ED with a direct impact on ED disposition. There are several viable management strategies that can result in safe discharge from the ED in the right patient population, and decision aids can be utilized to guide selection of appropriate patients for discharge.

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Performance of an expedited rhythm control method for recent onset atrial fibrillation in a community hospital

Cited by 8 publications

References 13 publications

Creation and Implementation of an Outpatient Pathway for Atrial Fibrillation in the Emergency Department Setting: Results of an Expert Panel

Creation and Implementation of an Outpatient Pathway for Atrial Fibrillation in the Emergency Department Setting: Results of an Expert Panel

Canada-wide mixed methods analysis evaluating the reasons for inappropriate emergency department presentation in patients with a history of atrial fibrillation: the multicentre AF-ED trial

Management and Disposition of Atrial Fibrillation in the Emergency Department: A Systematic Review

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