In this issue, we collaborated with the CJEM team to create a visual abstract on the November 2022 article “Effect of specialist consultation on emergency department revisits with uncomplicated recent-onset atrial fibrillation or flutter1”.
Uncomplicated recent-onset atrial fibrillation or flutter (AF/AFL) is often managed in the emergency department (ED) without specialist consultation. Canadian guidelines recommend consultation for this population once they receive rhythm and rate control and remain symptomatic or tachycardic2. However, there is significant variation in the amount of specialist consultations between sites.
The authors of this paper examined the effect of consultation by compared the risk of 30-day return to the emergency department, and length of stay, between those that received specialist consultations (medicine and/or cardiology) for uncomplicated AF/AFL and those that did not.
They found that specialist consultations did not significantly increase the risk of revisits within 30 days, but almost doubled the length of stay. When accounting for patient characteristics, the decision to obtain consultations was largely influenced by individual sites rather than patient factors. Overall, it may be appropriate to manage patients with uncomplicated AF/AFL in the ED without specialist consultation.
- 1.Lane DJ, Scheuermeyer FX, Nemnom MJ, Taljaard M, Stiell I. Effect of specialist consultation on emergency department revisits among patients with uncomplicated recent-onset atrial fibrillation or flutter. Can J Emerg Med. Published online September 22, 2022:760-769. doi:10.1007/s43678-022-00370-5
- 2.Stiell IG, Scheuermeyer FX, Vadeboncoeur A, et al. CAEP Acute Atrial Fibrillation/Flutter Best Practices Checklist. CJEM. Published online April 3, 2018:334-342. doi:10.1017/cem.2018.26