Hostname: page-component-848d4c4894-4rdrl Total loading time: 0 Render date: 2024-06-15T07:44:21.061Z Has data issue: false hasContentIssue false

MP29: Creation of the CAEP Acute Atrial Fibrillation/Flutter Best Practices Checklist

Published online by Cambridge University Press:  11 May 2018

I. G. Stiell*
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
F. Scheuermeyer
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
A. Vadeboncoeur
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
P. Angaran
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
D. Eagles
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
I. D. Graham
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
C. Atzema
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
P. Archambault
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
T. Tebbenham
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
K. de Wit
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
A. D. McRae
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
W. J. Cheung
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
M. Deyell
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
G. Baril
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
R. Mann
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
R. Sahsi
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
S. Upadhye
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
C. Clement
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
J. Brinkhurst
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
C. Chabot
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
D. Gibbons
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
Skanes
Affiliation:
University of Ottawa, Department of Emergency Medicine, Ottawa, ON
*
*Corresponding author

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Introduction: Patients with acute atrial fibrillation or flutter (AAFF) are the most common acute arrhythmia cases requiring care in the ED. Our goal was to adapt the existing Canadian Cardiovascular Society (CCS) AF Management Guidelines into an emergency physician-friendly best practices checklist. Methods: We chose to adapt, for use by emergency physicians, existing high-quality clinical practice guidelines (CPG) previously developed by the CCS using the GRADE system. We used the Canadian CAN-IMPLEMENT© process adapted from the ADAPTE Collaboration. We created an Advisory Committee consisting of 14 academic and community emergency physicians, three cardiologists, one PhD methodologist, and two patients. The Advisory Committee communicated by a two-day face-to-face meeting, teleconferences, and email. The checklist was prepared and revised through a process of feedback and discussions through ten iterations until consensus was achieved. We then circulated the draft checklist for comment to approximately 300 emergency medicine and cardiology colleagues whose written feedback was further incorporated into the final approved version. Results: The final CAEP ED AAFF Guidelines are comprised of two algorithms and four sets of checklists, organized by 1) Assessment and Risk Stratification, 2) Rhythm and Rate Control, 3) Long-term Stroke Prevention with the CHADS-65 Algorithm, and 4) Disposition and Follow-up. The guidelines have been endorsed by CAEP and accepted for publication in the Canadian Journal of Emergency Medicine. During the consensus and feedback processes, we addressed a number of issues and concerns. We highlighted the issue that many unstable patients are actually suffering from underlying medical problems rather than a primary arrhythmia. One controversial recommendation is to consider rate control or transesophageal echocardiography guided cardioversion if the duration of symptoms is 24-48 hours and the patient has two or more CHADS-65 criteria. We emphasize the importance of evaluating long-term stroke risk by use of the CHADS-65 algorithm and encourage ED physicians to prescribe anticoagulants where indicated. Conclusion: We have created the CAEP AAFF Best Practices Checklist which we hope will standardize and improve care of AAFF patients in all EDs across Canada. We believe that most of these patients can be managed rapidly and safely with ED rhythm control, early discharge, and appropriate use of anticoagulants.

Type
Moderated Posters Presentations
Copyright
Copyright © Canadian Association of Emergency Physicians 2018