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

• Published in: BMC cardiovascular disorders 2018-09, Vol.18 (1), p.179-179, Article 179
• Main Authors: Longino, Joseph, Chaddha, Ashish, Kalscheur, Matthew M, Rikkers, Anne M, Gopal, Deepak V, Field, Michael E, Wright, Jennifer M
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Algorithms; Ambulatory Care; Anti-Arrhythmia Agents - therapeutic use; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - therapy; Blood pressure; Cardiac arrhythmia; Cardiac patients; Cardiology; Cardiovascular disease; Care and treatment; Clinical Protocols; Cohort analysis; Colon; Costs; Decision Support Techniques; Diabetes; Diagnosis; Disease management; Electrocardiography; Emergency medical care; Emergency medicine; Emergency Service, Hospital; Endoscopy; Endoscopy, Gastrointestinal - adverse effects; Female; Fibrillation; Gastrointestinal endoscopy; Heart diseases; Heart failure; Humans; Hypertension; Hypotension; Male; Middle Aged; Pain; Patients; Referral and Consultation; Retrospective Studies; Risk Factors; Stroke; Studies; Treatment Outcome; Wisconsin
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-018-0915-0

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. 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. 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. 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.