Short Stay Management of Atrial Fibrillation 1st Edition by Frank Peacock, Carol Clark 9783319313863 331931386X

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ISBN 10: 331931386X
ISBN 13: 9783319313863
Author: Frank Peacock, Carol Clark

This book provides a road map for the efficient and successful management of atrial fibrillation (AF) in the short stay unit. It describes the problem, defines the measures of successful treatment, elucidates interventions, and supplies the tools for achieving quality care. Organized in four parts, it covers the impact of AF on patient populations; the presentation and management of AF; the transition to the outpatient environment; and systems management. Topics include the economic consequences of AF; cardioversion and cardiac implantable electronic devices in AF management; education of the AF patient and discharge planning; and quality metrics in AF. The book also provides order sheets and process criteria with which institutions can successfully manage the AF patient in the short stay unit, thus optimizing patient outcomes, patient satisfaction, and operational efficiencies. Short Stay Management of Atrial Fibrillation is a valuable resource for cardiologists, emergency medicine physicians, electrophysiologists, and other healthcare professionals involved in AF management.

Short Stay Management of Atrial Fibrillation 1st Table of contents:

Part I: Impact of the Disease
Chapter 1: Atrial Fibrillation: Epidemiology and Demographics
Risk Factors
Classification and Progression
References

Chapter 2: Pathophysiology of Atrial Fibrillation and Clinical Correlations
Background
Pathophysiology and Clinical Implications
Management of Atrial Fibrillation in Heart Failure
Paroxysmal AF and Acute Decompensated Heart Failure
Persistent or Permanent AF and Heart Failure
References

Chapter 3: The Economic Impact of Atrial Fibrillation in the US
Introduction
Epidemiology
Clinical Impact of Atrial Fibrillation
Economic Burden
Management Options
Noninvasive Approaches
Ablation
Treatment Venue Implications on Costs of AF
Atrial Fibrillation Clinics
Observation Services
Inpatient Admission
Summary
References

Part II: Presentation and Management
Chapter 4: Emergency Medical Services and Atrial Fibrillation
Introduction
Field Assessment
EMS Scope of Practice
Chief Complaint
Physical Examination
ECG
The EMS Challenge
Interventions
Aspirin
Pharmacologic Rate Control
Calcium Channel Blockers
Beta Blockers
Calcium Channel Blocker Versus Beta Blocker
Adenosine
Electrical Rate Control
Cardioversion/Defibrillation
Conclusions
References

Chapter 5: Symptoms of Atrial Fibrillation
Introduction
Symptoms
Palpitations
Dyspnea
Reduced Exercise Tolerance
Chest Discomfort, Pressure, Pain
Dizziness, Presyncope, Syncope
Other Symptoms
Asymptomatic
Symptom Scoring
Symptom-Directed Therapies
References

Chapter 6: Stroke and Other Complications of Atrial Fibrillation
Hemodynamic Compromise
Arrhythmogenic Complications
Thromboembolism and Stroke
Dementia
Summary
References

Chapter 7: Rate Control in Atrial Fibrillation
Rate Versus Rhythm Control
Rate Control
Special Considerations
Rate Control in Heart Failure
Lenient Versus Strict Rate Control
Aberrancy and Preexcitation
Unstable Atrial Fibrillation
Cocaine-Induced Atrial Fibrillation
References

Chapter 8: Diagnostic Testing in the Emergency Department of Atrial Fibrillation
History
Physical Exam
Diagnosis of Atrial Fibrillation on ECG
Atrial Activity in Atrial Fibrillation
Ventricular Response in Atrial Fibrillation
The QRS Complex in Atrial Fibrillation
Indicated Blood Work and Imaging
Echocardiogram
Summary
References

Chapter 9: Anticoagulation for Atrial Fibrillation in the Emergency Department or Observation Uni
Introduction
Pathophysiology of Thromboembolism in Atrial Fibrillation
Anticoagulation to Prevent Thromboembolism
Risk of Thromboembolism/Stroke
Risk of Bleeding
Choosing an Anticoagulant
Warfarin
Heparin and Low-Molecular-Weight Heparins
Dabigatran
Rivaroxaban
Apixaban
Edoxaban
Antiplatelet Agents
Practical Considerations
Decision to Anticoagulate
Choice of Anticoagulant
Patient Follow-Up
Conclusion
References

Chapter 10: Cardioversion and Acute Atrial Fibrillation Management
Introduction
The Unstable Patient with AF
Approach to Emergency Electrical Cardioversion
Management After EC, a Focus on Anticoagulation
The Stable Patient with AF
Previous Literature
Considerations Before Cardioversion
Method of Cardioversion
Pharmacologic Cardioversion
Flecainide and Propafenone
Ibutilide
Dofetilide
Vernakalant
Procainamide
Amiodarone
Pharmacologic Cardioversion Summary
“Antiarrhythmic” Effect of Rate-Controlling Agents
Electrical Cardioversion
Sedation
Considerations/Contraindications for Cardioversion of Stable AF
Disposition
Conclusion
References

Chapter 11: Procedural Sedation for Atrial Fibrillation Patients
Definitions and Goals of Procedural Sedation and Analgesia
Considerations in the Selection of Sedatives and Analgesics for Procedural Sedation: Patient F
Patients at Risk for Adverse Events During Procedural Sedation
Procedural Sedation and Analgesia in the Emergency Department
Cardioversion in the Emergency Department
Considerations in the Selection of Sedatives and Analgesics for Procedural Sedation: Sedatives
Steps in Procedural Sedation
References

Chapter 12: Risk Stratification in Atrial Fibrillation and Observation Unit Entry
Introduction
Stroke Risk Stratification Scores
Bleeding Risk Scores
Observation Unit Inclusion and Exclusion Criteria
Inclusion Criteria
Exclusion Criteria
References

Chapter 13: Cardiac Implantable Electronic Devices in the Short Stay Management of Atrial Fibrill
Device Basics
CIED Indications
Atrial Fibrillation
Coexisting Heart Failure
Sudden Cardiac Death
Cardiac Resynchronization Therapy
Device-Related Complications
Electrical Complications
Mechanical Complications
Infection
Device Data
Cardiac Rhythm
Heart Rate Variability
Patient Activity
Intrathoracic Impedance
Device Data in the Acute Care Setting
Conclusion
References

Chapter 14: Pitfalls in the Acute Management of Atrial Fibrillation
Incorrect Diagnosis
Irregular, Wide Complex Tachycardia
Other Supraventricular Tachycardias
Diagnostic Maneuvers
Failure to Appreciate the Importance of Duration of AF Episodes
Selecting Rate Versus Rhythm Control
Target Heart Rate (HR)
Appropriate Medication for HR Control
Systemic Anticoagulation
Cardioversion Without Appropriate Prior Systemic Anticoagulation
Failure to Confirm Therapeutic Systemic Anticoagulation for the Prior 3 Weeks
Failure to Consider Post-procedure Anticoagulation Prior to TEE/DCCV
Incorrect Assumption that Symptom Onset Is Equivalent to Arrhythmia Onset
Proceeding Immediately to TEE/DCCV for Minimally Symptomatic Rate-Controlled AF
Failure to Risk Stratify Patient for Thromboembolic Stroke and Hold Appropriate Discussion Regar
Failure to Start Systemic Anticoagulation Because of AF Duration or AF Burden
Failure to Start Systemic Anticoagulation Because of an Elevated Estimated Bleeding Risk
Not Initiating Anticoagulation Because a Patient Is Elderly or Is a “Fall Risk”
Failure to Consider Warfarin Versus Target-Specific Oral Anticoagulants (OAC)
Failure to Recognize Special Populations of Valvular AF and Hypertrophic Obstructive Cardiomyopa
Failure to Consider Systemic Anticoagulation in the Patient Status Post Left Atrial Appendectomy
Failure to Arrange for Adequate Follow-Up
Inappropriate Discontinuation of Systemic Anticoagulation
Pharmacologic Cardioversion
Failure to Consider Systemic Anticoagulation Prior to Initiating AAD Therapy
Choosing the Inappropriate AAD
Attempting Acute Pharmacologic Cardioversion with Ibutilide Without Appropriate Monitoring
Electrical Direct Current Cardioversion (DCCV)
Failure of Pre-procedure Preparations
Intraprocedural Error: Failure of Appropriate Synchronization
Failure to Distinguish Failure to Cardiovert Versus Early Return of Atrial Fibrillation (ERAF)
Incorrect Management of Pacemaker or Internal Cardioverter-­Defibrillator (ICD) Devices During C
Inadequate Post-procedure Monitoring
Special Circumstances
Failure to Recognize and Appropriately Treat Pre-excited Atrial Fibrillation
Digoxin
Initiation of Digoxin in the Inappropriate Patient
Inappropriate Interpretation of Digoxin Levels
Failure to Recognize Digoxin Toxicity
Inappropriate Management of the Patient with Digoxin Toxicity
References

Part III: Transition to the Outpatient Environment
Chapter 15: Education of the Atrial Fibrillation Patient in the Observation Unit
References

Chapter 16: Discharge Criteria
References

Chapter 17: Discharge Planning
Importance of Discharge Planning
Effective Discharge Planning
Contents of the Effective Discharge Plan
Medications
Symptom Assessment
Follow-Up and Additional Testing
How to Get It All Done
Conclusions
References

Chapter 18: Outpatient Medications in Atrial Fibrillation
Rate Control
Beta Blockers
Calcium Channel Blockers
Digoxin
Amiodarone
Practical Guidance for Rate Control
Rhythm Control
Flecainide
Propafenone
Pill in the Pocket
Disopyramide
Quinidine
Dofetilide
Amiodarone
Dronedarone
Sotalol
Conclusion
References

Part IV: Systems Management
Chapter 19: Atrial Fibrillation Accreditation
Introduction
Development of Atrial Fibrillation Certification
Development of Atrial Fibrillation v2 Accreditation
Accreditation Process
Why Pursue Atrial Fibrillation v2 Accreditation
References

Chapter 20: Quality Metrics in Atrial Fibrillation
Introduction
Metrics Common to All Protocols
Volume
Timing/Efficiency
Satisfaction
Safety
Quality Metrics Specific to Atrial Fibrillation
Documentation
Cardioversion
Discharge Planning
Conclusion
References

Chapter 21: Atrial Fibrillation Research in the Observation Unit and the Emergency Department
Background
Troponin and Afib
Cardioversion in Afib
Rate Control in Afib
The Risk of Stroke and Afib
Disposition and Afib
Limitations to Afib Research in the ED and OU
References

Chapter 22: Atrial Fibrillation Protocols

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Stay Management,Atrial Fibrillation,Frank Peacock,Carol Clark