RAFF5 Proposal: Project to Improve the Quality and Safety of the Immediate and Subsequent Care of Patients Seen in the Emergency Department With Acute Atrial Fibrillation and Flutter
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 1,108
- 试验地点
- 1
- 主要终点
- Improve the quality and safety of ED management of AF and AFL
研究概览
简要总结
Acute atrial fibrillation (AF) and flutter (AFL) are the most common arrhythmias requiring management in the emergency department (ED). They are characterized by sudden onset of a rapid heart rate which may be irregular (AF) or regular (AFL). Our focus is on episodes of acute AF or AFL which are usually less than 48 hours in duration and are highly symptomatic, requiring rapid treatment in the ED. Management guidelines for acute AF/AFL have changed substantially in recent years with several recent revisions published by the Canadian Cardiovascular Society (CCS) and the Canadian Association of Emergency Physicians (CAEP). The 2021 CAEP Acute Atrial Fibrillation/Flutter Best Practices Checklist (CAEP Checklist) was very recently published to assist ED physicians in Canada and elsewhere manage patients who present to the ED with acute AF/AFL (Figure 1).
The overall goal of this project is to improve the quality and safety of the immediate and subsequent care of patients seen in the ED with acute AF and AFL by implementing the principles of the CAEP Checklist at both The Ottawa Hospital (TOH) EDs and by working with TOH cardiologists to provide rapid cardiology follow-up processes for patients discharged from the ED. The Investigators propose a before-after cohort study using an interrupted time series design to evaluate implementation involving 720 patients at the two TOH EDs over a 24-month period.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •include all eligible patient visits to the participating EDs during the study period regardless of how they are managed.
- •include stable patients aged 18 and over,
- •presenting with an episode of acute AF or AFL of at least 3 hours duration,
- •where symptoms require ED management by rhythm or rate control.
排除标准
- •The study will exclude patients who have any of:
- •permanent AF;
- •deemed unstable and required immediate electrical cardioversion; or
- •primary presentation was for another condition rather than arrhythmia.
结局指标
主要结局
Improve the quality and safety of ED management of AF and AFL
时间窗: 14 day
the quality and safety of ED management based upon the CAEP Checklist management. best practices. The study team will use a score sheet which will identify specific managements for AF and AFL that are 1) optimal; 2) suboptimal; 3) unsafe.
次要结局
- Use of cardioversion (chemical or electrical) in the ED(Duration of the ED visit, approximately 4-12 hours.)
- prescription of OAC on discharge(Duration of the ED visit, approximately 4-12 hours.)
- use of rate control and the final heart rate at disposition(Duration of the ED visit, approximately 4-12 hours.)
- Adverse events attributable to medical management(Duration of the ED visit, approximately 4-12 hours.)
- consultations done in the ED by cardiology(Duration of the ED visit, approximately 4-12 hours.)