A systematic outpatient care program for patients discharged from the emergency department with atrial fibrillation significantly improved AFEQT quality of life scores by a mean of 20.0 points at 3 months.
Observational (n=128)
No
Does a systematic, protocol-based transition of care program improve quality of life and guideline-directed therapy in patients discharged from the ER with acute atrial fibrillation?
A systematic transition of care program for ER patients with atrial fibrillation is feasible and associated with significant improvements in quality of life and high rates of guideline-directed anticoagulation.
Mean Difference: 20
Absolute Event Rate: 76.4% vs 56.4%
p-value: p=<0.0001
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 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.
Angaran et al. (2015) conducted an observational in Atrial Fibrillation (n=128). Systematic outpatient care program (AF clinic referral and patient toolkit) vs. Baseline (pre-intervention) was evaluated on Atrial Fibrillation Effect on Quality-of-Life (AFEQT) Overall Score (MD 20.0, p=<0.0001). A systematic outpatient care program for patients discharged from the emergency department with atrial fibrillation significantly improved AFEQT quality of life scores by a mean of 20.0 points at 3 months.