Impact of a novel protocol for atrial fibrillation management in outpatient gastrointestinal endoscopic procedures: a retrospective cohort study

Autor: Michael E. Field, Anne M. Rikkers, Jennifer M. Wright, Ashish Chaddha, Deepak V. Gopal, Joseph Longino, Matthew M. Kalscheur
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system
Management of atrial fibrillation
Colonoscopy
030204 cardiovascular system & hematology
Chest pain
Endoscopy
Gastrointestinal
Decision Support Techniques
Post-intervention
Electrocardiography
03 medical and health sciences
Wisconsin
0302 clinical medicine
Clinical Protocols
Risk Factors
Internal medicine
Ambulatory Care
medicine
Humans
030212 general & internal medicine
Referral and Consultation
Aged
Retrospective Studies
Aged
80 and over
medicine.diagnostic_test
business.industry
Retrospective cohort study
Atrial fibrillation
Endoscopy
Emergency department
Middle Aged
medicine.disease
Cardiac surgery
Treatment Outcome
lcsh:RC666-701
Emergency medicine
Female
medicine.symptom
Emergency Service
Hospital
Cardiology and Cardiovascular Medicine
business
Anti-Arrhythmia Agents
Algorithms
Research Article
Zdroj: BMC Cardiovascular Disorders, Vol 18, Iss 1, Pp 1-5 (2018)
BMC Cardiovascular Disorders
ISSN: 1471-2261
Popis: Background Atrial fibrillation (AF) may result in procedure cancellations and emergency department (ED) referrals for patients presenting for outpatient GI endoscopic procedures. Such cancellations and referrals delay patient care and can lead to inefficient use of resources. Methods All consecutive patients presenting in AF for a colonoscopy or upper endoscopy to the University of Wisconsin Digestive Health Center between October 2013 and September 2014 were defined as the pre-intervention group (Group 1). In 2015, a protocol was initiated for peri-procedural management of patients presenting in AF, new onset or previously known. All consecutive patients after initiation of the protocol from October 2015 to September 2016 were analyzed as the post intervention group (Group 2). Patients with heart failure, hypotension, or chest pain were excluded from the protocol. Results One hundred nine and 141 patients were included in Groups 1 and Group 2, respectively. Following protocol initiation, patients were less likely to present to the ED (6.4% Group 1 vs. 1.4% Group 2, RR 0.22, p = 0.04). There was also a trend towards a reduction in procedure cancelations (5.5% Group 1 vs. 1.4% Group 2, RR 0.26, p = 0.08). All attempted procedures were completed and there were no complications in the intervention group. Conclusions Implementation of a standardized protocol for management of atrial fibrillation in patients presenting for outpatient gastrointestinal endoscopic procedures resulted in a significant decrease in emergency department visits with an additional trend toward decreased procedural cancellations without an increased risk of complications.
Databáze: OpenAIRE
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