Use of cardioversion in acute atrial fibrillation: A prospective audit from Christchurch Hospital

Arshad, Muhammad; Troughton, Richard W.; Smyth, D.; Daly, Matthew; Crozier, Ian; Melton, I.

doi:10.1016/j.hlc.2015.04.108

Cited by 1 publication

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“…Before the introduction of the Christchurch Hospital AF pathway in late 2015, electrical cardioversion played a major role in the management of patients with acute rapid AF, with direct current cardioversion being administered in ED or after admission to the cardiology ward. A prospective study of acute AF presentations at Christchurch Hospital prior to the introduction of the AF pathway found a significant proportion (27%) of patients had electrical cardioversion 16 . The initiation of anticoagulation was done at the treating clinician's discretion.…”

Section: Methodsmentioning

confidence: 99%

“…A prospective study of acute AF presentations at Christchurch Hospital prior to the introduction of the AF pathway found a significant proportion (27%) of patients had electrical cardioversion. 16 The initiation of anticoagulation was done at the treating clinician's discretion. The pathway was developed based on increasing evidence suggesting that a 'rate-and-wait' approach is safe.…”

Section: Acute Af Management Pre-and Post-af Pathway Implementationmentioning

confidence: 99%

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Implementation of an integrated emergency department acute atrial fibrillation pathway safely reduces cardioversions and hospitalisations: A comparative pre–post study

Addy,

Joyce,

Al‐Busaidi

et al. 2023

Emerg Medicine Australasia

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ObjectiveAtrial fibrillation/flutter (AF/AFL) accounts for high rates of ED presentations and hospital admissions. There is increasing evidence to suggest that delaying cardioversion for acute uncomplicated AF is safe, and that many patients will spontaneously revert to sinus rhythm (SR). We conducted a before‐and‐after evaluation of AF/AFL management after a change in ED pathway using a conservative ‘rate‐and‐wait’ approach, incorporating next working day outpatient clinic follow‐up and delayed cardioversion if required.MethodsWe performed a before‐and‐after retrospective cohort study examining outcomes for patients who presented to the ED in Christchurch, New Zealand, with acute uncomplicated AF/AFL in the 1‐year period before and after the implementation of a new conservative management pathway.ResultsA total of 360 patients were included in the study (182 ‘Pre‐pathway’ vs 178 ‘Post‐Pathway’). Compared to the pre‐pathway cohort, those managed under the new pathway had an 81.2% reduction in ED cardioversions (n = 32 vs n = 6), and 50.7% reduction in all cardioversions (n = 65 vs n = 32). There was a 31.6% reduction in admissions from ED (n = 54 vs n = 79). ED length of stay (3.9 h vs 3.8 h, net difference −0.1 h, 95% confidence interval [CI] −0.6 to 0.3), 1‐year ED AF representation (32.4% vs 26.4%, net difference −6.0% [95% CI −16.0% to 3.9%]), 1‐year ED ischaemic stroke presentation (2.2% in both groups) and 7‐day all‐cause mortality rates (hazard ratio 1.05 [95% CI 0.6 to 1.9]) were all similar.ConclusionsUsing a conservative ‘rate‐and‐wait’ strategy with early follow‐up for patients presenting to ED with AF/AFL can safely reduce unnecessary cardioversions and avoidable hospitalisations.

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Section: Methodsmentioning

confidence: 99%

Section: Acute Af Management Pre-and Post-af Pathway Implementationmentioning

confidence: 99%

Implementation of an integrated emergency department acute atrial fibrillation pathway safely reduces cardioversions and hospitalisations: A comparative pre–post study

Addy,

Joyce,

Al‐Busaidi

et al. 2023

Emerg Medicine Australasia

View full text Add to dashboard Cite

show abstract

Use of cardioversion in acute atrial fibrillation: A prospective audit from Christchurch Hospital

Cited by 1 publication

References 0 publications

Implementation of an integrated emergency department acute atrial fibrillation pathway safely reduces cardioversions and hospitalisations: A comparative pre–post study

Implementation of an integrated emergency department acute atrial fibrillation pathway safely reduces cardioversions and hospitalisations: A comparative pre–post study

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