Tuesday, February 14, 2017

Aggresive Management of AF

R.E.B.E.L.EM - February 13, 2017
Ref. Stiell IG et al. Outcomes for Emergency Department Patients with Recent-Onset Atrial Fibrillation and Flutter Treated in Canadian Hospitals. Ann Emerg Med 2017. PMID: 28110987
"Clinical Question:
What is the rate of adverse events occurring within 30 days of ED presentation for recent-onset AF/AFl in a system that utilizes an aggressive approach to management?
Author’s Conclusions:
“Although most recent-onset atrial fibrillation and flutter patients were treated aggressively in the ED, there were few 30-day serious outcomes. Physicians underprescribed oral anticoagulants. Potential risk factors for adverse events include longer duration from arrhythmia onset, previous stroke or transient ischemic attack, pulmonary congestion on chest radiograph, and not being in sinus rhythm at discharge. An ED strategy of sinus rhythm restoration and discharge in most patients is effective and safe”...
Clinical Bottom Line:
An aggressive approach to the management of recent-onset AF/AFl did not result in an unacceptable rate of adverse events. Adopting a rhythm control approach in these patients appears safe."