A Prospective, Randomized Trial of an Emergency Department Observation Unit for Acute Onset Atrial Fibrillation

Decker, Wyatt W.; Smars, Peter A.; Vaidyanathan, L.; Goyal, Deepi G.; Boie, Eric T.; Ganti, Latha; Packer, Douglas L.; Meloy, Thomas D.; Boggust, Andy; Haro, Luis H.; Laudon, Dennis A.; Lobl, Joseph K.; Sadosty, Annie T.; Schears, Raquel M.; Schiebel, Nicola; Hodge, David O.; Shen, Win Kuang

doi:10.1016/j.annemergmed.2007.12.015

Cited by 111 publications

(73 citation statements)

References 26 publications

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“…During 2 months of follow-up recurrence of AF was observed in about 25% of patients -the rate comparable to previous results [14], and the frequency of rehospitalization was about 19% in the whole group (27.7% in the paroxysmal AF) -in one of the earlier studies 33-35% of patients had recurrent visits on Emergency Department during a 6-months of follow-up [15]. In the Euro Heart Survey on Atrial Fibrillation registry, the rate of rehospitalization within 1 year was between 41% (first detected AF episode) and 54% (paroxysmal AF) [9].…”

Section: Discussionsupporting

confidence: 74%

Cardioversion differences among first detected episode, paroxysmal, and persistent atrial fibrillation patients in the RHYTHM AF registry in Poland

Kiliszek¹,

Opolski

Włodarczyk³

et al. 2015

Cardiol J

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Section: Discussionsupporting

confidence: 74%

Cardioversion differences among first detected episode, paroxysmal, and persistent atrial fibrillation patients in the RHYTHM AF registry in Poland

Kiliszek¹,

Opolski

Włodarczyk³

et al. 2015

Cardiol J

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“…[12][13][14] A prospective ED trial (n = 56) demonstrated no 6-month strokes, thromboembolic events, or deaths. 15 Recent meta-analyses have concluded that patients undergoing electrical cardioversion for atrial fibrillation lasting ‡7 days have a tendency toward increased stroke risk compared to patients treated with rhythm control alone. 16,17 The latter studies were not conducted in an ED setting and may involve a different group of patients than those encountered in the ED.…”

mentioning

confidence: 99%

Thirty‐day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter

Scheuermeyer

Grafstein

Stenstrom

et al. 2010

Academic Emergency Medicine

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Objectives: While the short-term (<7-day) safety and efficiency of electrical cardioversion for emergency department (ED) patients with atrial fibrillation or flutter have been established, the 30-day outcomes with respect to stroke, thromboembolic events, or death have not been investigated.Methods: A two-center cohort of consecutive ED patients undergoing cardioversion for atrial fibrillation or flutter between January 1, 2000, and September 30, 2007, was retrospectively investigated. This cohort was probabilistically linked with both a regional ED database and the provincial health registry to determine which patients had a subsequent ED visit or hospital admission, stroke, or thromboembolic event or died within 30 days. In addition, trained reviewers performed a detailed chart abstraction on 150 randomly selected patients, with emphasis on demographics, vital signs, medical treatment, and predefined adverse events. Hemodynamically unstable patients or those whose condition was the result of an underlying acute medical diagnosis were excluded. Data were analyzed by descriptive methods.Results: During the study period, 1,233 patients made 1,820 visits for atrial fibrillation or flutter to the ED. Of the 400 eligible patients undergoing direct-current cardioversion (DCCV), no patients died, had a stroke, or had a thromboembolic event in the following 30 days (95% confidence interval [CI] = 0.0 to 0.8% for all outcomes). A total of 141 patients were included in the formal chart review, with five patients (3.5%, 95% CI = 0.5% to 6.6%) failing cardioversion, six patients (4.3%, 95% CI = 0.9% to 7.6%) having a minor adverse event that did not change disposition, and five patients (3.5%, 95% CI = 0.5% to 6.6%) admitted to hospital at the index visit.Conclusions: Cardioversion of patients with atrial fibrillation or flutter in the ED appears to have a very low rate of long-term complications.ACADEMIC EMERGENCY MEDICINE 2010; 17:408-415 ª

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“…Six percent of patients returned to the ED within 7 days of the index visit. In 2008, our department published a prospective randomized trial evaluating an EDOU protocol for acute onset (<48 hours) AF that included 153 patients 17. Seventy‐five patients were randomized to EDOU management, and 9 patients (12%) were converted to inpatient admission.…”

Section: Discussionmentioning

confidence: 99%

“…Initial feasibility studies have indicated potential reductions in length of stay and cost without increasing adverse events or readmission rates 16, 17, 18…”

Section: Introductionmentioning

confidence: 99%

Impact of an Emergency Department Observation Unit Management Algorithm for Atrial Fibrillation

Bellew

Bremer

Kopecky

et al. 2016

JAHA

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BackgroundAtrial fibrillation (AF) is a common, growing, and costly medical condition. We aimed to evaluate the impact of a management algorithm for symptomatic AF that used an emergency department observation unit on hospital admission rates and patient outcomes.Methods and ResultsThis retrospective cohort study compared 563 patients who presented consecutively in the year after implementation of the algorithm, from July 2013 through June 2014 (intervention group), with 627 patients in a historical cohort (preintervention group) who presented consecutively from July 2011 through June 2012. All patients who consented to have their records used for chart review were included if they had a primary final emergency department diagnosis of AF. We observed no significant differences in age, sex, vital signs, body mass index, or CHADS2 (congestive heart failure, hypertension, age, diabetes mellitus, and prior stroke or transient ischemic attack) score between the preintervention and intervention groups. The rate of inpatient admission was significantly lower in the intervention group (from 45% to 36%; P<0.001). The groups were not significantly different with regard to rates of return emergency department visits (19% versus 17%; P=0.48), hospitalization (18% versus 16%; P=0.22), or adverse events (2% versus 2%; P=0.95) within 30 days. Emergency department observation unit admissions were 40% (P<0.001) less costly than inpatient hospital admissions of ≤1 day's duration.ConclusionsImplementation of an emergency department observation unit AF algorithm was associated with significantly decreased hospital admissions without increasing the rates of return emergency department visits, hospitalization, or adverse events within 30 days.

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A Prospective, Randomized Trial of an Emergency Department Observation Unit for Acute Onset Atrial Fibrillation

Cited by 111 publications

References 26 publications

Cardioversion differences among first detected episode, paroxysmal, and persistent atrial fibrillation patients in the RHYTHM AF registry in Poland

Cardioversion differences among first detected episode, paroxysmal, and persistent atrial fibrillation patients in the RHYTHM AF registry in Poland

Thirty‐day Outcomes of Emergency Department Patients Undergoing Electrical Cardioversion for Atrial Fibrillation or Flutter

Impact of an Emergency Department Observation Unit Management Algorithm for Atrial Fibrillation

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