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Canadian Journal of Cardiology

PATIENT PERCEPTIONS AFTER EMERGENCY DEPARTMENT VISITS FOR ATRIAL FIBRILLATION: UNNECESSARY FEAR?

      Background

      Guidelines suggest rate or rhythm control are both appropriate for acute management of atrial fibrillation (AF) in the emergency department (ED). However, patient perceptions after ED visit are not well documented or understood.

      Methods and Results

      Consecutive consenting patients who presented to a participating ED with the primary diagnosis of recent onset AF, and discharged from the ED, were enrolled in the ED and subsequently interviewed by telephone using a structured questionnaire, within 4 weeks of the visit. All management was at the discretion of the treating physician. Quantitative responses were recorded and analyzed using descriptive statistics. Patients (n= 356) were enrolled across 8 centers from 4 provinces, with 25% non-academic centers. Mean age was 67.3, +/- 13, with 45.0% female patients. In total, 52.8% were treated with cardioversion, with 35.7% initially receiving electrical cardioversion and 28.7% chemical cardioversion. 40.6% of patients who underwent chemical cardioversion subsequently required electrical cardioversion (Table 1). 84.8% of patients felt they had some knowledge of atrial fibrillation. 23.0% of patients presented to the ED because of reasons relating to fear and anxiety. 43.3% of patients believed they would have suffered stroke, myocardial infarction and/or death had they not presented to the ED. 89.6% of patients with this belief had been to the ED for AF in the past. Those who were treated with cardioversion were significantly more satisfied when asked “how satisfied were you with the care you received in the ED” than those who did not receive this intervention (8.31/10 compared to 5.71/10, p < 0.001).

      Conclusion

      Almost half of the patients presenting to the ED with AF, when questioned up to 4 weeks later, have fear of a life-threatening consequence of this arrhythmia, and have more subjective satisfaction with treatment if they receive electrical or chemical cardioversion compared to those not cardioverted. These findings suggest a need for better patient education on the goals of AF management.
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