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Heart, Lung and Circulation

Presentation, Treatment and Long-Term Outcomes of a Multidisciplinary Acute Atrial Fibrillation Pathway: A 12-Month Follow-Up Study

      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

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      Linked Article

      • Atrial Fibrillation Clinics: The Way of the Future
        Heart, Lung and CirculationVol. 31Issue 2
        • Preview
          In 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].
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