Background: Visits to the emergency room (ER)
for atrial fibrillation/flutter (AF) are common, but follow-up care is rarely
systematically organized and is often delayed.
Purpose: We conducted a pilot program to develop a
systematic, protocol-based system of care for patients presenting to the ER
with a primary diagnosis of AF.
Methods: Consecutive patients presenting to
the ER with ECG-documented AF at an urban teaching hospital were treated
according to a guideline-based care protocol, including a patient toolkit at ER
discharge, and systematic referral to a rapid access AF clinic. Consenting
patients received questionnaires on AF knowledge, patient satisfaction, and the
AFEQT questionnaire at first visit and three-month follow-up.
Results: Of the 321 patients with AF, 244 (76%) were
discharged from the ER and 166 (68%) were referred to the AF clinic for urgent follow-up.
Among 166 referred, 144 (87%) were seen, within a median 10.5 days (IQR 6-16.5
days); 128 (89%) patients agreed to participate in the study and 81% received a
toolkit in the ER. The mean age of patients seen in AF clinic was
63.6±13.2 years and 59% were male. Eighty-seven percent were aware of their
diagnosis, stroke risk (82%), possible complications (90%), treatment options
(86%) and benefits of adherence (86%). Severity of Atrial Fibrillation class
was > 2 in 51% at baseline; AFEQT scores increased from baseline (56.4±25.5)
to three months post-ER visit (76.4±20.0), a moderately large improvement in
QOL (p<0.0001). Seventy eight percent of patients with CHA2DS2-VASc score > 1 were
treated with an oral anticoagulant.
Conclusion: A systematic program to improve
patient transition of care from the ER to community clinic was associated with
prompt, guideline-based care, and high levels of patient disease awareness.
Quality of life scores improved substantially between the index ER visit and 3
Credits: Paul Angaran, MD; Zana Mariano, MA, CCRP; Vlad Dragan, BSc; Lily Zou, MSc; Clare L. Atzema, MD, MSc; Iqwal Mangat, MD; Paul Dorian, MD, MSc