Clinical management of atrial fibrillation: early interventions, observation, and structured follow-up reduce hospitalizations.
BACKGROUND
Novel facilities such as an intensive observation unit and an outpatient clinic could result in improving management of patients presenting with atrial fibrillation (AF).


METHODS
This observational study enrolled 3475 patients. Group 1 (1120 patients; years 2004-2005) was managed with standard approach; group 2 (992 patients; years 2006-2007) was managed with additional intensive observation; group 3 (1363 patients; years 2008-2009) was managed with additional intensive observation and outpatient clinic. Primary end point was admission to hospital. Secondary end points included modalities of rhythm conversion and administration of class IC vs class III antiarrhythmic drugs in patients with AF lasting less than 48 hours.


RESULTS
Lack of rhythm control, comorbidities, diabetes, and age were independent predictors of hospitalization. Admissions significantly decreased from group 1 (50%) to 2 (38%) and to 3 (24%) (P < .001). Interestingly, more than a quarter of patients in group 3 were referred to the outpatient clinic for short-term follow-up, eventually avoiding admission. Patients with AF lasting less than 48 hours (n = 2189) and without structural heart disease (n = 1685) achieved sinus rhythm in 89% of cases and were discharged. In these patients, early administration of antiarrhythmic drugs of class IC and III gained sinus rhythm in 80% and 20%, respectively (P < .001). Spontaneous conversion occurred in 26%; electrical, 17%; and pharmacological, 57%.


CONCLUSIONS
In patients with AF, beyond the standard approach, the novel organization with an additional intensive observation unit for early pharmacological interventions and an outpatient clinic for elective treatment and short-term follow-up significantly reduced admission irrespective of independent predictors of hospitalizations. Patients without structural heart disease treated with antiarrhythmic drugs achieved sinus rhythm in 89% of cases, mostly with class IC drugs.
Emergency Medicine, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy. aaaconti@hotmail.com
Alberto
A
Conti
Erica
E
Canuti
Yuri
Y
Mariannini
Gabriele
G
Viviani
Claudio
C
Poggioni
Vanessa
V
Boni
Riccardo
R
Pini
Simone
S
Vanni
Luigi
L
Padeletti
Gian Franco
GF
Gensini
D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D048909:Diabetes Complications / Q000628:therapy; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents