Journal article
The Iowa less aggressive protocol: A mixed-methods study on the novel treatment protocol of atrial fibrillation
The American journal of emergency medicine, Vol.45, pp.439-445
07/2021
DOI: 10.1016/j.ajem.2020.09.046
PMCID: PMC7994209
PMID: 33039220
Abstract
Atrial fibrillation is the most common cardiac dysrhythmia in the United States. Our aim was to determine if a novel protocol for management of atrial fibrillation was feasible to implement in an emergency department (ED). Interviews were conducted with ED physicians and physician assistants to identify themes in relation to the clinical use and impleon of the protocol.
A novel protocol was developed by a multi-disciplinary team and implemented in an academic ED. The protocol used cardiac computed tomography (CT) to rule out left atrial thrombus in patients with greater than 12 h of symptoms and high risk of thromboembolism, or any patient with greater than 48 h of symptoms. Patients who underwent cardiac CT or electrical cardioversion were followed up at 30 days via telephone to monitor for recurrence or adverse thromboembolic events. Providers were interviewed to identify themes regarding protocol usage, barriers to its use, and future changes to increase utilization.
Patients with atrial fibrillation in the ED were eligible for inclusion. Twenty-nine patients were treated using the protocol. Seven patients (24%) underwent cardiac CT prior to electrical cardioversion. Cardioversion success rate was 83%, with 69% of patients discharged home. Thirty-day follow-up was completed on 25 patients (86%). Six patients (24%) had reoccurrence of atrial fibrillation requiring subsequent cardioversion. No patients experienced stroke or thromboembolic event. Interviews were conducted with 14 providers. Usage barriers included time, availability, and additional work-up. Six subthemes were identified for future changes including EMR order set, frequent reminders, increased education, increased awareness, activation energy, and EMR pop-ups.
The Iowa Less Aggressive Protocol is a novel treatment protocol for the ED management of atrial fibrillation that was feasible to implement and use. Providers viewed the protocol favorably and identified areas of improvement for future use.
•This study describes a novel approach to atrial fibrillation in the ED.•Initial data suggests this protocol is safe for new onset atrial fibrillation.•Provides safe option for cardioversion with symptoms greater than 48 h.•ED clinicians identified barriers and facilitators to protocol implementation.•Identified areas for potential change with future studies.
Details
- Title: Subtitle
- The Iowa less aggressive protocol: A mixed-methods study on the novel treatment protocol of atrial fibrillation
- Creators
- Benjamin E. Christians - Roy J. and Lucille A. Carver College of MedicineChristopher J. Solie - University of IowaMorgan B. Swanson - University of IowaKarisa K. Harland - Roy J. and Lucille A. Carver College of MedicineCatherine Fairfield - Roy J. and Lucille A. Carver College of MedicineKelli L. Wallace - Roy J. and Lucille A. Carver College of MedicineNicholas M. Mohr - Roy J. and Lucille A. Carver College of Medicine
- Resource Type
- Journal article
- Publication Details
- The American journal of emergency medicine, Vol.45, pp.439-445
- DOI
- 10.1016/j.ajem.2020.09.046
- PMID
- 33039220
- PMCID
- PMC7994209
- NLM abbreviation
- Am J Emerg Med
- ISSN
- 0735-6757
- eISSN
- 1532-8171
- Publisher
- Elsevier Inc
- Grant note
- name: Institute for Clinical and Translational Sciences, award: U54TR001356
- Language
- English
- Date published
- 07/2021
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center; Law Faculty
- Record Identifier
- 9984295954402771
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