Reduced Hospitalisation and Improved Documentation of Risk Stratification – Impact of a New Acute Atrial Fibrillation (AF) Pathway

Abstract

Background: Atrial fibrillation is a common cause of acute hospitalisation. We evaluated the impact of a new clinical AF pathway on hospitalisation rates for AF and documentation of risk assessment for stroke and bleeding. Methods: To evaluate a new clinical pathway for management of AF, we performed a prospective single centre audit of the first hundred consecutive patients presenting with AF to the cardiology service at Christchurch Hospital between 01/10/2015 and 31/12/2015. Patient data was collected from clinical notes and the electronic record. Results: Among the first 100 patients presenting with AF [Males 67%, 69±12 years, HASBLED and CHADS2VA2Sc scores 2±1 and 2.5±1.7 respectively], 52 had prior history of AF/AFL and 75 presented with “acute persistent AF” as the primary diagnosis. Thirty-three patients were managed via the AF pathway, 22 of whom were discharged safely avoiding overnight hospital admission, with next day clinic review. There was one re-admission within thirty days and no stroke or bleeding complications. Patients managed with AF pathway tended to be younger (63±13 vs 71±11 years) with lower CHA2DS2VASc score (2±1.4 vs 3±1.8). 39/100 patents had CHADS2VA2Sc and HASBLED scores documented. Documentation of CHADS2VA2Sc and HASBLED scores was 100% in AF pathway group compared to only 10% in the cohort managed without AF pathway. Conclusion: Introduction of a new acute AF pathway was associated with reduced hospitalisation in low risk patients and with improved documentation of stroke and bleeding risk.