Decreasing Hospital Admissions from the Emergency Department for Acute Atrial Fibrillation

Acute atrial fibrillation (AAF) episodes are characterized by very rapid heart rates which have been present 48 hours and are highly symptomatic, disabling most patients.It is the most common type of palpitation treated in the Emergency Department (ED).

Some Canadian hospitals are able to discharge 95% of AAF patients seen and treated in the ED whereas others admit up to 40% of similar patients. In this era of hospital and ED crowding, we believe that discharge home directly from the ED is an effective and safe strategy that diminishes the burden on the patient and the health care system.

Our overall aim is to improve the care of patients presenting to the ED with AAF, while decreasing unnecessary hospitalizations across Canada by an absolute reduction of 20%.

We cannot improve the ED discharge rate without a better understanding of what impediments there are at the local level. To identify the barriers and enablers of ED discharge we plan to conduct local in-depth interviews of emergency physicians, cardiologists and AAF patients. This information will form the basis of our national survey of physicians and cardiologists. At the same time, we will convene a Clinical Practice Guideline working group composed of knowledge translation specialists, physicians (cardiology, emergency medicine, thrombosis), patients and stakeholders (Canadian Association of Emergency Physicians) to adapt the Canadian Cardiovascular Atrial Fibrillation Guidelines for ED use. This important preliminary work will set the stage for future projects including a randomized control implementation study, widespread knowledge translation strategies and ongoing monitoring of AAF hospital admissions.