Atrial Fibrillation Assessment

Atrial fibrillation and atrial flutter are both common conditions encountered by emergency physicians. Many of these patients do not require hospitalization and can be safely and effectively managed in an outpatient setting.

ACEP has developed an evidence-based pathway and bedside tool to aid in better assessment and management of these patients, thus ensuring that hospitalization rates can be reduced as appropriate patients are safely transitioned to outpatient care

Review the AFIB bedside tool before you answer the question.

Which of the following is not an accurate portrayal of some of the considerations codified in this decision pathway?

A) Some patients discharged in sinus rhythm or atrial fibrillation or flutter need anticoagulation. Bleeding risk factors should be managed in those who have HAS-BLED scores of 3 or greater.

B) Patients must be carefully assessed for factors that might exclude them from outpatient management (eg, accompanying diagnosis requiring inpatient care, renal failure, pregnancy, or social barriers to outpatient follow-up).

C) As one requirement for possible outpatient discharge, patients must have had conversion to sinus rhythm for greater than an hour OR adequate symptom management and rate control while still in in atrial fibrillation or flutter.

D) For patients discharged still in atrial fibrillation or atrial flutter, start anticoagulation if the HAS-BLED score is less than 3 and the CHAS-VASc sore is greater than 2.