title: Analysis of current management of atrial fibrillation in the acute setting: GEFAUR-1 study.
abstract: OBJECTIVE
  Limited information relative to the management of atrial fibrillation in the emergency department (ED) daily practice is available. This study evaluates current management of atrial fibrillation in this setting to identify areas for practice improvement.
  
  
  METHODS
  This was a prospective multicenter observational study carried out in 12 EDs. Adults in whom atrial fibrillation was demonstrated in an ECG obtained in the ED were included. Clinical variables and atrial fibrillation management in the ED were prospectively collected by the treating physicians using a standardized questionnaire. Patients with rapid ventricular response (>100 beats/min) were considered eligible for rate control, and patients with recent-onset episodes (<48 hours) were eligible for rhythm control.
  
  
  RESULTS
  Of 1,178 patients, 41% presented with a rapid ventricular response and 21% had recent-onset episodes. Rhythm control was attempted in 42% of eligible patients, with antiarrhythmic drugs in 88% of cases (I-C drugs in 44% of patients; amiodarone in 43% of patients). Overall effectiveness of pharmacologic cardioversion was 63% (amiodarone 54.5%, flecainide 93%), whereas electrocardioversion was effective in 87.5% of cases. Rate control was performed in 68.3% of eligible patients (overall effectiveness 47.8%); digoxin was used in 67% of cases (effectiveness 45%). Both strategies were selected in 4.5% of cases, whereas no treatment for atrial fibrillation was performed in 60% of patients.
  
  
  CONCLUSIONS
  In our ED population, rate-control effectiveness is poor and rhythm control is not attempted in most recent-onset episodes. Methods to improve rate-control effectiveness, the selection of patients for rhythm control, and the use of electrocardioversion appear warranted.
authors.affiliation: Arrhythmia Division, Spanish Society of Emergency Medicine, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: del Arco
authors.forename: Alfonso
authors.initials: A
authors.lastname: Martín
authors.forename: Pedro
authors.initials: P
authors.lastname: Laguna
authors.forename: Pedro
authors.initials: P
authors.lastname: Gargantilla
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000628:therapy*; D004554:Electric Countershock / Q000706:statistics & numerical data; D004635:Emergency Medicine / Q000379:methods* / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents