Related Experiment Video
Updated: Aug 31, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Development of a Care Pathway for Atrial Fibrillation Patients in the Emergency Department
Duc H Do1, Breno Bernardes-Souza1, Michael Merjanian2
1From the UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Insights
This study introduces a new emergency department pathway for atrial fibrillation (AF) management. It aims to safely discharge patients with expedited follow-up, reducing hospital admissions.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Atrial fibrillation (AF) is a growing public health concern, increasing emergency department (ED) visits and hospitalizations.
- Current ED management guidelines for acute AF episodes lack clarity, leading to frequent hospital admissions despite evidence supporting safe discharge.
- Existing protocols often rely on cardiology consultation, highlighting a need for ED physician-driven management strategies.
Purpose of the Study:
- To develop and implement an evidence-based, systematic pathway for managing acute atrial fibrillation in the emergency department.
- To improve patient care by focusing on acute stabilization, optimal anticoagulation, and safe ED discharge with expedited outpatient follow-up.
- To reduce unnecessary hospital admissions and the associated economic burden of atrial fibrillation.
Main Methods:
- Established a multidisciplinary collaboration to create the University of California-Cardioversion, Anticoagulation, Rate Control, Expedited Follow-up/Education Atrial Fibrillation Pathway.
- Designed the pathway to be primarily driven by emergency department physicians, differentiating it from cardiologist-led protocols.
- Focused on acute AF stabilization, adherence to anticoagulation best practices, and criteria for safe ED discharge.
Main Results:
- The pathway facilitates acute stabilization of AF patients in the ED.
- It promotes adherence to best practices for anticoagulation management.
- It aims to reduce unnecessary hospital admissions by enabling safe ED discharges with expedited follow-up.
Conclusions:
- The developed pathway offers a systematic, evidence-based approach to managing acute AF in the ED.
- This ED physician-driven protocol can improve patient care and reduce hospital admissions for AF.
- Implementing such strategies is crucial given the rising prevalence of AF and the need for cost-effective management.
Abstract:
Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence is continuously increasing in the United States, leading to a progressive rise in the number of disease-related emergency department (ED) visits and hospitalizations. Although optimal long-term outpatient management for AF is well defined, the guidelines for optimal ED management of acute AF episodes is less clear. Studies have demonstrated that discharging patients with AF from the ED after acute stabilization is both safe and cost effective; however, the majority of these patients in the United States and in our institution are admitted to the hospital. To improve care of these patients, we established a multidisciplinary collaboration to develop an evidence-based systematic approach for the treatment and management of AF in the ED, that led to the creation of the University of California-Cardioversion, Anticoagulation, Rate Control, Expedited Follow-up/Education Atrial Fibrillation Pathway. Our pathway focuses on the acute stabilization of AF, adherence to best practices for anticoagulation, and reduction in unnecessary admissions through discharge from the ED with expedited outpatient follow-up whenever safe. A novel aspect of our pathway is that it is primarily driven by the ED physicians, while other published protocols primarily involve consulting cardiologists to guide management in the ED. Our protocol is very pertinent considering the current trend toward increased AF prevalence in the United States, coupled with a need for widespread implementation of strategies aimed at improving management of these patients while safely reducing hospital admissions and the economic burden of AF.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:29Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
01:25Dysrhythmias VI: Management of Dysrhythmias
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:23Cardiopulmonary Resuscitation III: AED Use
01:26Acute Coronary Syndrome V: Nursing Management