Impact of an emergency department-initiated clinical protocol for the evaluation and treatment of atrial fibrillation.
OBJECTIVE
Published data supporting the best practice for patients with atrial fibrillation (AF) presenting to the emergency department (ED) are limited. Our objective was to evaluate the impact of an AF clinical protocol initiated in the ED with early follow-up in a specialty AF outpatient clinic.


METHODS
This was a single-center prospective study of all consented patients with AF who were discharged from the ED through the AF clinical pathway and were then seen in the AF clinic. The primary endpoint was the rate of 90-day hospitalization/ED visits. Secondary endpoints included adherence to established AF anticoagulation guidelines, rate of thromboembolic events, quality of life, and patient satisfaction.


RESULTS
One hundred consecutive patients were enrolled in the study. Within 90 days, 15 had ED visits and 4 were hospitalized, whereas none developed thromboembolic complications. There were significant increases in the Atrial Fibrillation Effect on QualiTy of life survey quality of life (67.3 ± 24.8 vs. 89.2 ± 15.7; P < 0.001) and patient satisfaction (66.4 ± 25.3 vs. 77.9 ± 22.8; P < 0.001) scores from baseline to 90 days. Of the 29 patients with CHADS2 score ≥2, 20 (69%) were discharged from the AF clinic with oral anticoagulation.


CONCLUSIONS
We describe a novel approach to the care of patients with AF presenting to the ED. Usage of the ED-initiated AF clinical pathway with early follow-up in a protocol-driven AF clinic was associated with low readmission rates, no thromboembolic complications at 90 days, improved quality of life, and high patient satisfaction.
From the *Department of Cardiology, Division of Electrophysiology, Frederik Meijer Heart and Vascular Institute, Grand Rapids, MI; †Department of Internal Medicine, Michigan State University College of Human Medicine, East Lansing, MI; ‡Department of Research, Spectrum Health, Grand Rapids, MI; §Internal Medicine Residency Program, Grand Rapids Medical Education Partners/Michigan State University, Grand Rapids, MI; ¶Hospitalist Medicine, Spectrum Health, Grand Rapids, MI, ‖Department of Emergency Medicine, Spectrum Health, Grand Rapids, MI; **Department of Research, Grand Rapids Medical Education Partners, Grand Rapids, MI; ††Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI; and ‡‡Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI.
Darryl A
DA
Elmouchi
Stacie
S
VanOosterhout
Purushothaman
P
Muthusamy
Mohsin
M
Khan
Cathy
C
Puetz
Alan T
AT
Davis
Michael D
MD
Brown
D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy; D002985:Clinical Protocols; D019468:Disease Management; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D017060:Patient Satisfaction; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D020521:Stroke / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants