Aim
Atrial fibrillation/flutter (AF/AFL) is associated with high rates of emergency department
(ED) visits and acute hospitalisation. A recently established multidisciplinary acute
AF treatment pathway seeks to avoid hospital admissions by early discharge of haemodynamically
stable, low risk patients from the ED with next-working-day return to a ward-based
AF clinic for further assessment. We conducted a preliminary analysis of the clinical
outcomes of this pathway.
Methods
We retrospectively reviewed clinical records of all patients assessed at the AF clinic
at Christchurch Hospital, New Zealand, over a 12-month period. Data related to presentation,
patient characteristics, treatment, and 12-month outcomes were analysed.
Results
A total of 143 patients (median age 65, interquartile range: 57–74 years, 59% male,
87% European) were assessed. Of these, 87 (60.8%) presented with their first episode
of AF/AFL. Spontaneous cardioversion occurred in 41% at ED discharge, and this increased
to 73% at AF clinic review. Electrical cardioversion was subsequently performed in
16 patients (11.2%), and 16 (11.2%) ultimately required hospital admission (eight
to facilitate electrical cardioversion). At a median of 1 day, 83.9% were discharged
from the AF clinic in sinus rhythm. During 12-month follow-up, there were 25 AF-related
hospitalisations (20 patients, 14%) and one patient underwent electrical cardioversion;
additionally, one patient had had a stroke and eight had bleeding complications giving
a combined outcome rate of 6.3%.
Conclusion
Utilising a rate-control strategy with ED discharge and early return to a dedicated
AF clinic can safely prevent the majority of hospitalisations, avert unnecessary procedures,
and facilitate longitudinal care.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study.Circulation. 2014; 129: 837-847
- 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.Eur Heart J. 2016; 37: 2893-2962
- Atrial fibrillation in New Zealand primary care: prevalence, risk factors for stroke and the management of thromboembolic risk.Eur J Prev Cardiol. 2017; 24: 311-319
- Identification, risk assessment, and management of patients with atrial fibrillation in a large primary care cohort.Int J Cardiol. 2018; 254: 119-124
- Trends in hospitalization for atrial fibrillation: epidemiology, cost, and implications for the future.Prog Cardiovasc Dis. 2015; 58: 105-116
- Costs of atrial fibrillation in five European countries: results from the Euro Heart Survey on atrial fibrillation.Europace. 2008; 10: 403-411
- Emergency department visits for atrial fibrillation in the United States: trends in admission rates and economic burden from 2007 to 2014.J Am Heart Assoc. 2018; 7 (pii: e009024)
- National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.Heart Lung Circ. 2018; 27: 1209-1266
- Nurse-led protocol-based atrial fibrillation clinic associated with high quality care for patients.Heart Lung Circ. 2019; 28: S222
- Implementation of an emergency department atrial fibrillation and flutter pathway improves rates of appropriate anticoagulation, reduces length of stay and thirty-day revisit rates for congestive heart failure.CJEM. 2018; 20: 392-400
- Impact of a multidisciplinary treatment pathway for atrial fibrillation in the emergency department on hospital admissions and length of stay: results of a multi-center study.J Am Heart Assoc. 2019; 8: e012656
- A Multicenter randomized trial to evaluate a chemical-first or electrical-first cardioversion strategy for patients with uncomplicated acute atrial fibrillation.Acad Emerg Med. 2019; 26: 969-981
- “Wait and See” approach to the emergency department cardioversion of acute atrial fibrillation.Emerg Med Int. 2011; : 545023
- Reduced hospitalisation and improved documentation of risk stratification – impact of a new acute atrial fibrillation (AF) pathway.Heart Lung Circ. 2016; 25: S9
- Improvement in risk assessment and management of anticoagulation in patients with AF in an Australasian setting: impact of a new acute af pathway.Heart Lung Circ. 2016; 25: S29-S30
- Ethical Guidelines for Observational Studies: Observational Research, Audits and Related Activities.Revised edition. Ministry of Health, Wellington2012 (Available at)
- Outcomes of patients presenting with primary or secondary atrial fibrillation with rapid ventricular rate to the emergency department.Ann Acad Med Singapore. 2018; 47: 438-444
- Thirty-day and 1-year outcomes of emergency department patients with atrial fibrillation and no acute underlying medical cause.Ann Emerg Med. 2012; 60: 755-765.e2
- Novel care pathway for patients presenting to the emergency department with atrial fibrillation.Circ Cardiovasc Qual Outcomes. 2018; 11: e004129
- Interventions to improve emergency department-related transitions in care for adult patients with atrial fibrillation and flutter.J Emerg Med. 2019; 57: 501-516
- Impact of an emergency department-initiated clinical protocol for the evaluation and treatment of atrial fibrillation.Crit Pathw Cardiol. 2014; 13: 43-48
- Likelihood of spontaneous cardioversion of atrial fibrillation using a conservative management strategy among patients presenting to the emergency department.Am J Cardiol. 2019; 124: 1534-1539
- Likelihood of spontaneous conversion of atrial fibrillation to sinus rhythm.J Am Coll Cardiol. 1998; 31: 588-592
- RACE 7 ACWAS Investigators. Early or delayed cardioversion in recent-onset atrial fibrillation.N Engl J Med. 2019; 380: 1499-1508
- Use of flecainide for the treatment of atrial fibrillation.Am J Cardiol. 2020; 125: 1123-1133
- Why don't physicians follow clinical practice guidelines? A framework for improvement.JAMA. 1999; 282: 1458-1465
- HRS/EHRA/APHRS/LAHRS/ACC/AHA Worldwide practice update for telehealth and arrhythmia monitoring during and after a pandemic.J Am Coll Cardiol. 2020; 76: 1363-1374
- The transition to a "virtual practice" in primary care during the COVID-19 pandemic: experience from one medical centre in New Zealand.N Z Med J. 2020; 133: 91-98
- Planning telehealth for older adults with atrial fibrillation in rural communities: understanding stakeholder perspectives.Clin Nurs Res. 2019; 28: 130-149
Article info
Publication history
Published online: June 28, 2021
Accepted:
May 16,
2021
Received in revised form:
April 1,
2021
Received:
February 11,
2021
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Atrial Fibrillation Clinics: The Way of the FutureHeart, Lung and CirculationVol. 31Issue 2
- PreviewIn this edition of Heart, Lung and Circulation, Al-Busaidi et al. [1] present the long-term outcomes of patients managed through their atrial fibrillation (AF) clinical pathway with early review at an outpatient AF clinic following discharge from the emergency department. The pathway was aimed at reducing unnecessary hospital admissions and improving adherence to guideline-based AF treatment. AF is the most common sustained arrhythmia and is associated with increased risk of cardiovascular morbidity, stroke, dementia, and death [2].
- Full-Text
- Preview
