Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
Can J Cardiol. 2024 Sep;40(9):1554-1562. doi: 10.1016/j.cjca.2024.01.037. Epub 2024 Feb 7.
We sought to improve the immediate and subsequent care of emergency department (ED) patients with acute atrial fibrillation (AF) and flutter (AFL) by implementing the principles of the Canadian Association of Emergency Physicians AF/AFL Best Practices Checklist.
This cohort study included 3 periods: before (7 months), intervention introduction (1 month), and after (7 months), and was conducted at a major academic centre. We included patients who presented with an episode of acute AF or AFL and used multiple strategies to support ED adoption of the Canadian Association of Emergency Physicians checklist. We developed new cardiology rapid-access follow-up processes. The main outcomes were unsafe and suboptimal treatments in the ED.
We included 1108 patient visits, with 559 in the before and 549 in the after period. In a comparison of the periods, there was an increase 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, although 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. Although 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.
NCT05468281.
我们试图通过实施加拿大急诊医师协会房颤/房扑最佳实践检查表的原则，来改善急诊科（ED）急性房颤（AF）和房扑（AFL）患者的即刻和后续护理。
这项队列研究包括 3 个时期：前期（7 个月）、干预引入期（1 个月）和后期（7 个月），并在一家主要的学术中心进行。我们纳入了因急性 AF 或 AFL 发作而就诊的患者，并采用多种策略支持 ED 采用加拿大急诊医师协会检查表。我们制定了新的心脏病学快速随访流程。主要结局是 ED 中不安全和不适当的治疗。
我们纳入了 1108 次就诊，前期 559 次，后期 549 次。在两个时期的比较中，化学复律的使用率有所增加（20.6%对 25.0%；绝对差异[AD]，4.4%）和电复律的使用率有所增加（39.2%对 51.2%；AD，12.0%）。更多的患者出院时窦性心律恢复（66.9%对 75.0%；AD，8.1%）。在随访心脏病学诊所就诊的比例从 24.2%增加到 39.9%（AD，15.7%），且平均就诊时间显著缩短（103.3 天对 49.0 天；AD，-54.3 天）。不安全病例很少（0.4%对 0.7%），尽管不适当治疗的比例有所增加（19.5%对 23.1%），但患者的总体结局仍很好。
我们成功地改善了 ED 急性 AF/AFL 患者的护理，并实现了更频繁和更快速的心脏病学随访。尽管不安全管理的病例并不常见，且患者的结局很好，但医生仍有机会改善他们对急性 AF/AFL 患者的治疗。
NCT05468281。
