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Most emergency department patients undergoing cardioversion for atrial fibrillation (AF) or flutter receive guideline-based anticoagulation. However, improved follow-up and care pathways are needed to reduce high revisit rates after AF cardioversion.

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Pharmacology

Background:

  • Atrial fibrillation (AF) and flutter are common arrhythmias requiring cardioversion.
  • International guidelines recommend specific anticoagulation protocols for patients undergoing direct current cardioversion (DCCV).
  • Adherence to these guidelines in the emergency department (ED) setting is crucial for patient safety and outcomes.

Purpose of the Study:

  • To evaluate adherence to anticoagulation guidelines during DCCV for AF/flutter in an ED.
  • To identify patient characteristics and outcomes associated with guideline adherence.
  • To assess the impact of anticoagulation management on ED revisit rates.

Main Methods:

  • Retrospective study of 158 patients undergoing DCCV for AF/flutter in a metropolitan ED (2020-2023).
  • Data collected on arrhythmia details, anticoagulation timing, and outcomes.
  • Analysis based on 2024 European Society of Cardiology criteria for anticoagulation.

Main Results:

  • High adherence to pre-cardioversion (94%) and post-cardioversion (90%) anticoagulation guidelines was observed.
  • Direct oral anticoagulants (DOACs) were frequently used, with appropriate dosing in 88.2%.
  • Higher adherence was noted in patients with CHA2DS2-VA score ≥2 (p<0.01); however, ED revisit rates were high (17.1% at 30 days, 46.2% at 12 months).

Conclusions:

  • Guideline-concordant anticoagulation is common for ED cardioversion of AF/flutter.
  • Variability in anticoagulation dosing and post-procedure management persists, especially in lower-risk patients.
  • Enhanced follow-up and structured care pathways are essential to mitigate high revisit rates post-ED cardioversion.