We sought to improve the immediate and subsequent care of ED patients with acute atrial fibrillation (AF) and flutter (AFL) by implementing the principles of the CAEP AF/AFL Best Practices Checklist.
This cohort study included three periods: before (7 months), intervention introduction (1 month), and after (7 months), and was conducted at a major academic centre. We included patients presenting with an episode of acute AF or AFL and employed multiple strategies to support ED adoption of the CAEP Checklist. We developed new cardiology rapid-access follow-up processes. The main outcomes were unsafe and suboptimal treatments in the ED.
We included 1,108 patient visits, with 559 in the before and 549 in the after period. Comparing periods, we found an increase both in use of chemical cardioversion (20.6% vs 25.0%; absolute difference (AD) 4.4%) and in electrical cardioversion (39.2% vs 51.2%; AD 12.0%). More patients were discharged with sinus rhythm restored (66.9% vs 75.0% (AD 8.1%). The proportion seen in a follow-up cardiology clinic increased from 24.2% to 39.9% (AD 15.7%) and the mean time until seen decreased substantially (103.3 vs 49.0 days; AD -54.3 days). There were very few unsafe cases (0.4% vs 0.7%) and, while there was an increase in suboptimal care (19.5 vs 23.1%), overall patient outcomes were excellent.
We successfully improved the care for ED patients with acute AF/AFL and achieved more frequent and more rapid cardiology follow-up. While cases of unsafe management were uncommon and patient outcomes were excellent, there are opportunities for physicians to improve their care of acute AF/AFL patients.
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