Coordination of Atrial Fibrillation Management in the Emergency Department and Outpatient Settings

Historically, a majority of patients presenting to the Emergency Department (ED) with a primary diagnosis of atrial fibrillation (AF) have been admitted to an inpatient unit. Treatment protocols for AF management in the ED have been shown to reduce the need for inpatient admissions and improve adherence to treatment guidelines for the administration of oral anticoagulation (OAC) therapy. Establishment of outpatient follow-up is a necessary part of discharging patients with AF from the ED. Follow-up planning can present a challenge for clinicians in the ED setting, as many patients who present to the ED with AF do not have an established cardiologist or cardiac electrophysiologist. Inability to arrange timely outpatient follow-up can therefore represent a barrier to discharge from the ED. The presence of outpatient clinics dedicated to AF management can help clinicians in the ED to manage patients with AF more efficiently. In this review, we describe the components of dedicated AF clinics. We also describe aspects of patient care that can be improved through implementation of dedicated AF outpatient clinics. These improvements include enhanced adherence with OAC therapy, reduced hospital re-admissions, improved patient outcomes, and reduced healthcare costs.