Planning and monitoring of patients for electrical cardioversion for atrial fibrillation
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Published on: May 26, 2015
J H H Deuling1, R P Vermeulen, M D Smit
1Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Insights
Nurse practitioners (NPs) safely manage waiting lists for electrical cardioversion (ECV) for persistent atrial fibrillation (AF), reducing procedure postponements. Inadequate international normalised ratio (INR) remains the primary reason for delays.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Elective electrical cardioversion (ECV) for persistent atrial fibrillation (AF) is frequently postponed.
- Reasons for these postponements are not well-documented.
Purpose of the Study:
- To evaluate the waiting list for elective ECV in persistent AF.
- To identify reasons for procedure postponement.
- To compare physician-led versus nurse practitioner (NP)-led waiting list management.
- To assess the safety of the anticoagulation policy.
Main Methods:
- A study of 250 consecutive patients with persistent AF undergoing elective ECV.
- Evaluation of procedure postponement rates and reasons.
- Comparison of outcomes between physician and NP management.
- Monitoring of bleeding and thromboembolic complications.
Main Results:
- 77% of patients received ECV within 5-6 weeks.
- Inadequate international normalised ratio (INR) was the main reason for postponement.
- NP-managed patients had significantly fewer postponements due to inadequate INR (4%) compared to physician-managed patients (16%).
Conclusions:
- Inadequate INR is the primary cause for postponing ECV.
- NP management of ECV waiting lists is safe and effective.
- NP management leads to a reduction in procedure postponements on admission.
Objectives:
This study evaluated the waiting list for elective electrical cardioversion (ECV) for persistent atrial fibrillation (AF), focusing on when and why procedures were postponed. We compared the effects of management of the waiting list conducted by physicians versus management by nurse practitioners (NPs) and we evaluated the safety of our anticoagulating policy by means of bleeding or thromboembolic complications during and after ECV.
Background:
Not all patients selected for ECV receive their treatment at the first planned instance due to a variety of reasons. These reasons are still undocumented.
Methods:
We evaluated 250 consecutive patients with persistent AF admitted to our clinic for elective ECV.
Results:
Within 5 to 6 weeks, 186 of 242 patients (77%) received ECV. The main reason for postponing an ECV was an inadequate international normalised ratio (INR); other reasons included spontaneous sinus rhythm and switch to rate control. A total of 23 of the 147 patients (16%) managed by the research physician were postponed due to an inadequate INR at admission versus 4 out of 98 patients (4%) managed by NPs (p = 0.005)
Conclusion:
An inadequate INR is the main reason for postponing an ECV. Management of ECV by NPs is safe and leads to less postponing on admission.
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