Atrial Fibrillation: Would You Prefer a Pill or 150 Joules?

Atzema, Clare L.

doi:10.1016/j.annemergmed.2015.07.012

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…Potential drivers of this practice include prior research suggesting no benefit in outcomes from a preference of rhythm over rate control, the perceived or actual burden on ED resources to perform cardioversion, prior versions of specialty society guidelines, and lack of payer scrutiny of short‐stay AF inpatient hospitalizations or readmissions versus other conditions such as chest pain, syncope, and congestive heart failure . More recently, the recognition of patient preference for returning to sinus rhythm has been added to the reasons to advocate for an early cardioversion strategy . Nevertheless, the experience of other countries can provide an example of alternative evidence‐based management that results in fewer hospitalizations without evidence of worse outcomes, a result relevant to U.S. EDs faced with heavy burdens of inpatient crowding and ED boarding …”

Section: Discussionmentioning

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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Section: Discussionmentioning

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

View full text Add to dashboard Cite

show abstract

“…It should also be taken into account that in certain hospitals, there is a lack of ED resources to perform electrical cardioversion, as well as a lack of payer scrutiny of short hospitalizations or readmissions due to AF, in contrast to other conditions such as angina, syncope, and decompensated heart failure [52]. On the other hand, the very encouraging results yielded by aggressive AF management protocols, resulting in significantly fewer hospitalizations without evidence of worse outcomes, along with data suggesting a patient preference for sinus rhythm restoration, constitute the fundamental reasons for pursuing an early cardioversion strategy [53][54][55][56][57].…”

Section: Discussionmentioning

confidence: 99%

Aggressive Rhythm Control Strategy in Atrial Fibrillation Patients Presenting at the Emergency Department: The HEROMEDICUS Study Design and Initial Results

Tsiachris,

Argyriou,

Tsioufis

et al. 2024

JCDD

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Atrial fibrillation has progressively become a more common reason for emergency department visits, representing 0.5% of presenting reasons. Registry data have indicated that about 60% of atrial fibrillation patients who present to the emergency department are admitted, emphasizing the need for more efficient management of atrial fibrillation in the acute phase. Management of atrial fibrillation in the setting of the emergency department varies between countries and healthcare systems. The most plausible reason to justify a conservative rather than an aggressive strategy in the management of atrial fibrillation is the absence of specific guidelines from diverse societies. Several trials of atrial fibrillation treatment strategies, including cardioversion, have demonstrated that atrial fibrillation in the emergency department can be treated safely and effectively, avoiding admission. In the present study, we present the epidemiology and characteristics of atrial fibrillation patients presenting to the emergency department, as well as the impact of diverse management strategies on atrial-fibrillation-related hospital admissions. Lastly, the design and initial data of the HEROMEDICUS protocol will be presented, which constitutes an electrophysiology-based aggressive rhythm control strategy in patients with atrial fibrillation in the emergency department setting.

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“…It should also be taken into account that in certain hospitals there is a lack of ED resources to perform electrical cardioversion, as well as a lack of payer scrutiny of short hospitalizations or readmissions due to AF, in contrast to other conditions such as angina, syncope, and decompensated heart failure [42]. On the other hand, the very encouraging results yielded by aggressive AF management protocols, resulting in significantly fewer hospitalizations without evidence of worse outcomes, along with data suggesting patient preference for sinus rhythm restoration, constitute the fundamental reasons for pursuing an early cardioversion strategy [43][44][45][46][47][48].…”

Section: Discussionmentioning

confidence: 99%

Aggressive Rhythm Control Strategy in Atrial Fibrillation Patients Presented at the Emergency Department. The HEROMEDICUS Study Design and Initial Results

Tsiachris,

Argyriou,

Tsioufis

et al. 2024

Preprint

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Atrial fibrillation has progressively become a more common reason for emergency de-partment visits, representing 0.5% of presenting reasons. Registry data have indicated that about 60% of atrial fibrillation patients who present to the emergency department are admitted, emphasizing the need for more-efficient management of atrial fibrillation in the acute phase. Management of atrial fibrillation in the setting of emergency department varies between countries and health care systems. The most plausible reason to justify a conservative rather than aggressive strategy in the management of atrial fibrillation is the absence of specific guidelines from diverse societies. Several trials of atrial fibrillation treatment strategies, including cardioversion, have demonstrated that atrial fibrillation in emergency department can be treated safely and effectively, avoiding admission. In the present study, we review the epidemiology and characteristics of atrial fibrillation pa-tients presenting to the emergency department will be reviewed, as well as the impact of diverse management strategies on atrial fibrillation-related hospital admissions. Lastly, the design and initial data of the HEROMEDICUS protocol, which constitutes an elec-trophysiology-based aggressive rhythm control strategy in patients with atrial fibrillation in the emergency department setting will be presented.

show abstract

Atrial Fibrillation: Would You Prefer a Pill or 150 Joules?

Cited by 5 publications

References 23 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

Aggressive Rhythm Control Strategy in Atrial Fibrillation Patients Presenting at the Emergency Department: The HEROMEDICUS Study Design and Initial Results

Aggressive Rhythm Control Strategy in Atrial Fibrillation Patients Presented at the Emergency Department. The HEROMEDICUS Study Design and Initial Results

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