Authors (including presenting author) :
So CW(1), Lui CT(1), Fung HT(1), Chan TH(1)
Affiliation :
(1) Accident and Emergency Department, Tuen Mun Hospital
Introduction :
A standardized protocol for management of selected low risk atrial fibrillation (AF) was implemented in the Emergency Medicine ward (EMW) of Tuen Mun Hospital (TMH) since 2016. Patients with new onset AF, palpitation in known paroxysmal AF, and fast AF breakthrough, will undergo protocol-driven risk stratification. Stable low risk patients could be admitted to the EMW.
This protocol integrated risk stratification, rate control, anticoagulation, workup for underlying cause, discharge pathway and referral. Short term follow-up would be provided by emergency physicians.
Objectives :
This is an audit to evaluate the efficiency and effectiveness of this clinical protocol, including the compliance to protocol-driven care in EMW, thromboembolic risk stratification, anticoagulation and patient outcome.
Methodology :
All admission of AF through TMH AED were screened from 1 Nov 2018 to 31 Oct 2019. Low risk cases that are eligible for protocol-driven care were included. Cases of newly found AF which were managed in EMW were contrasted with those managed in medical wards.
Result & Outcome :
141 cases fulfilling low risk criteria of AF were included in the analysis, including 70 patients with newly found AF. Others were admitted for palpitation with known paroxysmal AF and fast AF breakthrough. Within these 70 cases of newly found AF, 30 patients were admitted to EMW for protocol-driven care with compliance of 43%. Comparing these patients admitted to EMW and medical wards, there was no major difference in demographics and clinical complexity. Standardized thromboembolic risk assessment were documented in 58% of cases in EMW which is comparable to the medical wards (55%). There was no difference in anticoagulation use for patients with moderate to high embolic risk (defined as CHA2DS2-VASc score >1) in EMW versus medical wards (69% vs 73%). The average length-of-stay was shorter with protocol-driven care in EMW than in medical wards (1.29 days vs 2.75 days, p< 0.05). There was no difference in the reattendance rate due to AF-related diseases within 14 days (20.8% vs 17.5%, p=0.741). There was no major AF-related morbidity and mortality within the audit period. To conclude, protocol-driven management of low-risk AF in EMW is comparable to medical wards in clinical outcome and safety, with notably shorter hospital length-of-stay. However, the compliance to the clinical protocol and standardized thromboembolic risk assessment should be enhanced.
