Clinical governance of acute atrial fibrillation: application of a specific diagnostic/therapeutical protocol

The aim of our study was to estimate the clinical efficacy and the practical effectiveness of using a guideline for acute AF (acute atrial fibrillation) treatment, considering a particular form of intensive short-care observation (OBI). We considered, retrospectively, data collected from 2001 to 2003 of 1358 consecutive patients that arrived in our Emergency Department for acute AF (present for less then 30 days). From March 2002, we started to use a specific diagnostic/therapeutical protocol (PDT), prepared in accordance with the Cardiology Unit. This system allow to stratify the patients in different risk’s groups, and permit the treatment in ED of the patients in the lower risk classes, thus avoiding admittance of these patients in Cardiology or Medicine wards. During year 2002, the percentage of patients admitted versus those discharged from the ED, was significantly decreased as compared to year 2001, and this trend was further increased in year 2003. This change of trend was particularly evident in subjects older than 70, that usually face a higher risk or severe comorbidity (65% admitted in 2001, 46% admitted in 2003). 96% of the patients discharged from ED were in sinus rhythm; the patients discharged with AF (4% of the total number) were those that arrived at the ED more than 48 hours after the beginning of the arrhythmia, and they have been treated with oral anticoagulants and were considered for delayed cardioversion, or rate-control strategy (depending upon the clinical setting). The antiarrhythmic class IC drugs are first choice tools, safe and effective for acute AF in ED/OBI settings, in patients without pre-existing heart problems. The reduction of admission rate is also very important for limiting the costs of treatment of this pathological condition, without any further risks for the patients. In conclusion, our data confirm that using this specific protocol in our hospital, allow a safe treatment in ED without definitive admission in a large cohort of patients with acute AF.