Manejo de la fibrilación auricular en un servicio de urgencias. Concordancia de la práctica clínica habitual con las Guías Europeas

Résumé

BACKGROUND AND OBJECTIVE. Atrial fibrillation (AF) must often be managed in emergency services. We aimed to study how acute AF is managed in terms of treatment strategies (rate control, rhythm control, and thromboprophylaxis) used under routine conditions in an emergency department and whether practice follows European guidelines. METHODS. Observational, cross-sectional, single-center study in the emergency department of Hospital Universitario Araba in Spain between October 2019 and May 2020. We studied all patients whose electrocardiograms detected AF. RESULTS. A total of 386 patients were included; 280 (72.5%) had previously known AF and 106 (27.5%) had newly diagnosed AF. The mean (SD) age was 76.0 (11.5) years, 44% were aged 80 years or older, and 56% were men. The rates of adherence to protocol were 80.4% for rhythm control, 77.9% for rate control, and 65.2% for thromboprophylaxis. The management approaches used most often were antiarrhythmic drugs (rhythm control); for rate control beta-blockers were usually used, and acenocoumarol was most often chosen as the initial anticoagulant treatment. The main departures from guidelines involved the choice of the best treatment for rhythm control, the optimization of beta-blocker dosages for tachycardia and anticoagulant dosages, and the use of direct-action anticoagulants and antiplatelet treatment interruption in patients without indications for combined therapy. CONCLUSIONS. Adherence to guidelines for the treatment of rhythm and rate control is high, although there is room for improvement in the management of thromboprophylaxis.