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. 2015 Feb 28;7(5):1187.
doi: 10.4022/jafib.1187. eCollection 2015 Feb-Mar.

The Atrial Fibrillation Therapies after ER visit: Outpatient Care for Patients with Acute AF - The AFTER3 Study

Paul Angaran  1 , Zara Mariano  1 , Vlad Dragan  1 , Lily Zou  1 , Clare L Atzema  2 , Iqwal Mangat  1 , Paul Dorian  1
Affiliations

The Atrial Fibrillation Therapies after ER visit: Outpatient Care for Patients with Acute AF - The AFTER3 Study

Paul Angaran et al. J Atr Fibrillation. .

Abstract

Background: Visits to the emergency room (ER) for atrial fibrillation/flutter (AF) are common, but follow-up care is rarely systematically organized and is often delayed.

Purpose: We conducted a pilot program to develop a systematic, protocol-based system of care for patients presenting to the ER with a primary diagnosis of AF.

Methods: Consecutive patients presenting to the ER with ECG-documented AF at an urban teaching hospital were treated according to a guideline-based care protocol, including a patient toolkit at ER discharge, and systematic referral to a rapid access AF clinic. Consenting patients received questionnaires on AF knowledge, patient satisfaction, and the AFEQT questionnaire at first visit and three-month follow-up.

Results: Of the 321 patients with AF, 244 (76%) were discharged from the ER and 166 (68%) were referred to the AF clinic for urgent follow-up. Among 166 referred, 144 (87%) were seen, within a median 10.5 days (IQR 6-16.5 days); 128 (89%) patients agreed to participate in the study and 81% received a toolkit in the ER. The mean age of patients seen in AF clinic was 63.6±13.2 years and 59% were male. Eighty-seven percent were aware of their diagnosis, stroke risk (82%), possible complications (90%), treatment options (86%) and benefits of adherence (86%). Severity of Atrial Fibrillation class was > 2 in 51% at baseline; AFEQT scores increased from baseline (56.4±25.5) to three months post-ER visit (76.4±20.0), a moderately large improvement in QOL (p<0.0001). Seventy eight percent of patients with CHA2DS2-VASc score > 1 were treated with an oral anticoagulant.

Conclusions: A systematic program to improve patient transition of care from the ER to community clinic was associated with prompt, guideline-based care, and high levels of patient disease awareness. Quality of life scores improved substantially between the index ER visit and 3 months post-visit.

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Figures

Figure 1.
Figure 1.. AFTER3 Patient Recruitment (March 2012 - August 2013)
Admitted – Patients admitted to hospital; Discharged from ED – Patients discharged home from the ED; Not referred – Patients not referred to the AF Clinic; Referred to AF Clinic – Referrals were faxed/copied and placed in ED binder and patient was given an appointment at ED discharged; Not seen in AF Clinic – Patients cancelled their appointment or were no shows; Seen in AF Clinic – Patients who came for their scheduled AF Clinic appointment; Not Enrolled into AFTER3 – Patient declined, limited English, met exclusion criteria; Recruited into AFTER3 – Patients who met inclusion criteria and were recruited into the AFTER3 Study
Figure 2A.
Figure 2A.. Stroke Prevention Treatment in the AF Clinic (N=128)
*N=126 (data is missing for 2 patients), † 1 started ASA, ‡ 1 started ASA AF – Atrial fibrillation; OAC – oral anticoagulant; D/C – Discharged; AFC – Atrial Fibrillation Clinic; GP – General Practitioner
Figure 2B.
Figure 2B.. Stroke Prevention Treatment in the AF Clinic with a CHA2DS2-VASc≥2 (N=72)
* CHA2DS2-VASc≥2 (N=72) – (data is missing for 2 patients), AF – Atrial fibrillation; OAC – oral anticoagulant; D/C – Discharged; AFC – Atrial Fibrillation Clinic; GP – General Practitioner
See this image and copyright information in PMC

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