Effectiveness of a community Atrial Fibrillation clinic

Atrial fibrillation (AF) is the most common sustained abnormal cardiac rhythm in adults, accounting for over 60,000 emergency department (ED) presentations in Aotearoa per year. Historically, many patients presenting to ED in AF with rapid ventricular response were managed with cardioversion either acutely or following admission to hospital.

Christchurch ED adopted a “rate-and-wait” strategy in 2015 following growing literature that this was an effective management. This involved providing rate control for patients who presented acutely to ED with AF, with discharge to an onsite follow-up clinic the next day. This proved effective with the majority of patients reverting to sinus rhythm within 24 hours, avoiding unnecessary cardioversion and hospital admission. In July 2022, we adopted a new community off site follow-up clinic run out of Acute Demand at the Pegasus 24 hour Surgery.

The data we will present follows the outcomes of patients following a “rate-and-wait” strategy with community clinic follow-up. Specific outcomes we will be presenting are: rhythms at clinic, disposition following clinic including cardioversions, rate control and anticoagulation prescribing rates, adverse events (bleeding, thromboembolic, hospital representation) and subsequent changes we made to the pathway following this research. We hope that this will further encourage other areas to adopt a rate-and-wait approach following the success of the offsite clinic.