205 Clinical Audit on the Management of Patients Presenting to Emergency Department With Atrial Fibrillation at a Regional Hospital

Abstract

Atrial fibrillation (AF) is the commonest arrhythmia and is a significant public health and emergency department (ED) burden. Although the mainstay of AF treatment is rate or rhythm control and anticoagulation, there is substantial variation in AF management in ED. We assessed the management of AF in patients presenting to Cairns Hospital ED over a 1 year period by conducting a retrospective audit. There were 374 presentations with AF from 1/10/2018 to 30/9/2019. 237 were randomly selected for audit. This included first diagnosed AF (30 %), paroxysmal AF (47 %), persistent/permanent AF (23%). In terms of AF management, 122 (51.3%) of patients received rate control and 116 (48.3%) received rhythm control. Of the cases considered for rhythm control - 58 patients received pharmacological treatment and 48 received electrical cardioversion. Only 12 patients (5%) were referred for electrophysiology follow-up. 67.6% of patients had a CHA2DS2VASc score of ≥2, of which 72.0% were appropriately anticoagulated. 10.1% of anticoagulated patients received warfarin while 87.3% received NOACs. Adjunct therapies - IV Magnesium was prescribed in >2/3 of all patients. Although Cairns ED is compliant to anticoagulation guidelines, AF management by rate or rhythm control is almost 50/50% and the use of IV Magnesium (not evidence-based) is used in >2/3. This audit highlights the need for guidelines for appropriate and consistent management and ongoing care of AF patients treated in ED.