123 Re-audit of nurse led DC cardioversion service: efficiency, outcomes, comparisons and anti-arrhythmic drug (AAD) use

A new nurse led DC cardioversion list was first started at Ipswich hospital in 2016 in order to improve the previously existing Registrar led service. Initial audit of this service, which was conducted in 2016 for Registrar led service, found two main aspects which needed improvement i.e., better adherence to prescribing AAD drugs as per ESC guidelines and improving waiting time for this outpatient DC cardioversion service. In the following years, re-audit in 2020 and various local presentations were arranged to increase adherence in prescribing appropriate AAD drugs along with drafting an effective DC cardioversion referral form was taken place. This all showed a significant improvement in our service when re-audited in 2020 and there was 47% increase in the use of AAD drugs were noted from 2016. Similarly, now we have conducted a similar retrospective re-audit and reviewed 100 patients who have undergone DC cardioversion from January 2022 until Dec 2022 and compared it with previous year's audits. It is encouraging to know that 80% patients were prescribed AAD drugs prior to their DC cardioversion in 2022 which was 71% in 2020. 60% of the patients were continued with long term AAD's as noted on their follow ups as compared to 42.1% in 2016. Anti-arrhythmic drugs used were Amiodarone (most common), Sotalol (2nd) and least commonly used drug was flecainide. Some of the patients were also just found to be on rate-controlling medications rather than rhythm controlling drugs which were Bisoprolol, Diltiazem, metoprolol, verapamil and digoxin. DC cardioversion success rate was 93% in 2022 as compared to 73% in 2020. Out of all successful DC cardioversions, only 6 patients had failed DC cardioversion and 2 of them were on rate controlling medications. Conclusion In summary, there was a good uptrend noticed in prescribing AAD drugs to patients undergoing DC cardioversion as compared to previous years. This likely is related to increase in DC cardioversion success rate seen in the year 2022. Though there can also be several other individual factors related to each patient. At the same time, maintenance AAD drugs prescribing still needs to be encouraged further (Class 2A indication as per ESC guidelines) as there were still 40% patients who were not found to be on any maintenance AAD drugs and many of them failed to remain in sinus rhythm upon consecutive follow ups. Furthermore, there are various anti-arrhythmic drugs which could be considered depending upon individual case particularly if there were any contra-indications found related to common AAD drugs. We will also continue to re-audit the same topic to further improve our DC cardioversion service to achieve better outcomes for our patients. Conflict of Interest Nil