CAEP Atrial Fibrillation Guide

The CAEP Acute Atrial Fibrillation Guide has been created to assist emergency physicians in Canada and elsewhere manage patients who present to the emergency department (ED) with acute/recent-onset atrial fibrillation (AF) or flutter (AFL). The checklist focuses on symptomatic patients with acute AF or AFL, i.e. those with recent-onset episodes (either first detected, recurrent paroxysmal or recurrent persistent episodes) where the onset is generally less than 48 hours but may be as much as seven days. These are the most common acute arrhythmia cases requiring care in the ED. These are the most common acute arrhythmia cases requiring care in the ED. Canadian emergency physicians are known for publishing widely on this topic and for managing these patients quickly and efficiently in the ED.

The 2018 Checklist project was funded by a research grant from the Cardiac Arrhythmia Network and the resultant guidelines were formally endorsed by the Canadian Association of Emergency Physicians (CAEP). We chose to adapt, for use by emergency physicians, existing high-quality clinical practice guidelines (CPG) previously developed by the Canadian Cardiovascular Society (CCS).5-7 These CPGs were developed and revised using a rigorous process that is based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system of evaluation.8 With the assistance of our PhD methodologist (IG), we used the recently developed Canadian CAN-IMPLEMENT© process adapted from the ADAPTE Collaboration.9 10 We created an Advisory Committee consisting of ten academic emergency physicians (one also expert in thrombosis medicine), four community emergency physicians, three cardiologists, one PhD methodologist, and two patients. Our focus was four key elements of ED care: assessment and risk stratification, rhythm and rate control, short-term and long-term stroke prevention, and disposition and follow-up. The advisory committee communicated by face-to-face meetings, teleconferences, and email. The checklist was prepared and revised through a process of feedback and discussions on all issues by all panel members. These revisions went through ten iterations until consensus was achieved. We then circulated the draft checklist for comment to approximately 300 emergency medicine and cardiology colleagues. Finally, the CAEP Standards Committee posted the Checklist online for all CAEP members to provide feedback.