CE-452772-4 DELAYED DETECTION OF AND INTERVENTION FOR INCIDENT AF IN HOSPITALIZED PATIENTS IS COMMON AND CONSEQUENTIAL

Abstract

Incident atrial fibrillation (AF) affects c.10% of hospitalized patients. Early AF management mitigates risk of complications (e.g. stroke, heart failure, care escalation) yet recognition and intervention is sub-optimal. Prior work here showed a median 1.5 day delay from automated algorithmic AF detection to clinical action in the ICU. The purpose of this work was to characterize AF recognition and intervention in cardiology floor patients, and the consequences of any delays. Retrospective review of 483 consecutively admitted patients from 12/24/20-12/20/21 having at least one algorithmically-detected significant AF episode (≥6 min duration = ‘clinically significant’). The algorithm uses multiple time and non-linear-domain characteristics of the time series data to ensure sensitive and specific AF detection. Characteristics of AF episode (Table 1), clinical response, and occurrence of prespecified AF-related complications were identified in patient charts, along with demographics and medical history. 34.2% (165/483) of patients had a clinically significant AF event that was missed. 20.3% (98/483) of patients had AF that was clinically detected after algorithmic detection. Within this group, 72 patients received clinical interventions: 21 received “early” interventions within one hour of AF onset; 51 received “late” interventions >1 hour after AF onset. 26 patients received no intervention despite clinical detection. 9.8% (5/51) of the late intervention patients experienced a complication, while 4.8% (1/21) of the early intervention patients experienced a complication. 19.2% (5/26) of patients clinically noted but with no intervention experienced a complication. Having a history of AF made likelihood of delayed intervention more likely [74.5% (38/51) vs 33.3% (7/21)]. Compared with caucasian patients, African American patients were less likely to receive early intervention for incident AF [24.1% (20/83) vs 0% (0/8)]. Despite widespread continuous cardiorespiratory monitoring, patients admitted to the cardiology floor of our tertiary hospital experience considerable and medically significant delays in the detection and management of incident AF. Delayed intervention results in higher complication rates. Having a prior history of AF and being African American were also associated with longer delays before AF intervention.