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Original Research

Open Access

Heterogeneity in the role of emergency physicians and treatment of acute atrial fibrillation in emergency departments—results of the International Atrial Fibrillation Background (AFiB) Study

  • Markus Holmberg1
  • Ville Hällberg1,*,
  • Hjalti M Björnsson2
  • Timothy H Rainer3
  • Colin A Graham4
  • Marc B Sabbe5
  • Wilhelm Behringer6
  • Gayle Galletta7
  • Hans Domanovits8
  • Harri Pikkarainen9
  • Bruce M Lo10
  • Christophe Laurent11
  • Pascal Vanelderen12,13
  • Ari Palomäki1,14

1Department of Emergency Medicine, Kanta-Häme Central Hospital, 13530 Hämeenlinna, Finland

2Department of Emergency Medicine, Landspitali—The National University Hospital of Iceland, 101 Reykjavik, Iceland

3Emergency Medicine, University of Hong Kong, Hong Kong, China

4Emergency Medicine, Chinese University of Hong Kong, Hong Kong, China

5University Hospitals of Leuven, 3000 Leuven, Belgium

6Department of Emergency Medicine, Jena University Hospital, 07747 Jena, Germany

7University of Massachusetts Medical Center, Worcester, MA 01605, USA

8Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria

9Department of Emergency Medicine, Päijät-Häme Central Hospital, 15850 Lahti, Finland

10Department of Emergency Medicine, Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, MA 23510, USA

11Emergency Department, Heilig Hartziekenhuis Mol, 2400 Mol, Belgium

12Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium

13Department of Life Sciences, University of Hasselt, 3500 Diepenbeek, Belgium

14Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland

DOI: 10.22514/sv.2024.038 Vol.20,Issue 4,April 2024 pp.25-32

Submitted: 12 October 2023 Accepted: 28 November 2023

Published: 08 April 2024

*Corresponding Author(s): Ville Hällberg E-mail: ville.hallberg@omahame.fi

Abstract

The consept of emergency departments (EDs) with specialized teams of emergency physicians originated in the United Kingdom and the United States during the 1970s and was expanded across most European countries in the twenty-first century. Among the various cardiac arrhythmias encountered in EDs, atrial fibrillation (AF) is the most prevalent, contributing to ED congestion. Existing guidelines offer multiple treatment options for acute-onset AF occurring within 48 hours. The aim of The Atrial Fibrillation Background Study is to evaluate treatment strategies, practices and the role of emergency physicians in managing acute-onset AF in Western medical tradition across Europe, the United States and China (Hong Kong). The data for this nonexperimental survey were collected through a questionnaire administered to the medical director or a senior physician at each of the 12 participating EDs. We obtained information regarding the total number of physicians employed in these EDs, their respective specialties, and the patient caseloads they managed. Additionally, we gathered data on the diagnostic and treatment protocols employed for atrial fibrillation (AF). In the investigated EDs in Hong Kong, the United Kingdom and the United States, patients were treated by emergency physicians. Comparatively, many European EDs primarily relied on physicians with traditional medical specialties. Diagnostic methods employed for acute AF ranged from point-of-care testing to comprehensive laboratory panels and echocardiography. In terms of AF treatment, rate control was the preferred approach in Hong Kong and the USA EDs, while rhythm control was preferred in European settings. Regarding rhythm control, there were considerable variations in preferences between pharmacological and electrical cardioversion methods. Findings from the AFiB Study highlight the growing significance of emergency physicians in the management of acute AF, as well as the divergent treatment approaches for acute AF observed in EDs between Europe and the United States.


Keywords

Emergency department; Role of emergency physicians; Acute-onset atrial fibrillation; Treatment strategy; Treatment practices; Atrial fibrillation diagnostics; Rhythm control; Rate control


Cite and Share

Markus Holmberg,Ville Hällberg,Hjalti M Björnsson,Timothy H Rainer,Colin A Graham,Marc B Sabbe,Wilhelm Behringer,Gayle Galletta,Hans Domanovits,Harri Pikkarainen,Bruce M Lo,Christophe Laurent,Pascal Vanelderen,Ari Palomäki. Heterogeneity in the role of emergency physicians and treatment of acute atrial fibrillation in emergency departments—results of the International Atrial Fibrillation Background (AFiB) Study. Signa Vitae. 2024. 20(4);25-32.

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