Disparities in management of new-onset atrial fibrillation in the emergency department despite adherence to the current guidelines: data from a large metropolitan area

Francesco Franceschi, Francesco Buccelletti, S Di Somma, A Galante, F Pugliese, F Alegiani, G Bertazzoni, Ng Silveri, Jm Legramante

Risultato della ricerca: Contributo in rivistaArticolo in rivista

10 Citazioni (Scopus)

Abstract

Atrial Fibrillation management is still a matter for debate. Past research has largely been based on the outpatient setting in which patients are followed during ambulatory visits. Very little data exist on the optimal management of AF in the Emergency Department (ED). This study investigated which factors drive different AF treatments in the ED, describing their use in different hospitals. Finally, the efficacy of different strategies in terms of cardioversion in the ED was analyzed. Charts of patients treated for atrial fibrillation (AF) were collected in 6 EDs in a large metropolitan area over a 24-consecutive month period and were reviewed and analysed. Demographics, comorbidities, treatment strategy and ED outcome were collected. Inclusion criteria were symptom onset <3 weeks and stable hemodynamic conditions at presentation. A propensity score was used to adjust for baseline clinical characteristics and to compare the efficacy of different treatments. 3,085 patients were included in the analysis. Variables associated with a rhythm control strategy were onset of symptoms <48 h, age, dyspnea, palpitations, renal failure and the presence of a mechanical valve. Different EDs applied different strategies in terms of drugs used and the electrocardioversion rate, showing heterogeneity in AF management. Adjusting for the propensity score, electrocardioversion and antidysrhythmic drugs of class Ic were more effective than a wait-and-watch strategy in the ED. Despite international guidelines being respected, AF management is heterogeneous in different ED settings. A rhythm control strategy with electrocardioversion and Class Ic drugs is more effective than a wait-and watch approach during the ED visit. Further research, toward an evidence-based approach to the emergent management of AF in the ED, is still needed.
Lingua originaleEnglish
pagine (da-a)149-156
Numero di pagine8
RivistaINTERNAL AND EMERGENCY MEDICINE
Volume6
DOI
Stato di pubblicazionePubblicato - 2011

Keywords

  • Aged
  • Atrial Fibrillation
  • Electric Countershock
  • Emergency Service, Hospital
  • Female
  • Guideline Adherence
  • Heart Rate
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Propensity Score
  • Retrospective Studies
  • Rome
  • Statistics, Nonparametric
  • Time Factors
  • Urban Population

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