Grant: Operating Grant: Priority Announcement (IHSPR)

Atrial fibrillation (AF) and atrial flutter (AFL) are cardiac rhythm problems where there is an irregular, rapid heart rate. We will study patients with recent-onset episodes of AF or AFL (RAFF) where the onset is less than 48 hours & heart rates are 150 per minute. RAFF is the most common rhythm disorder managed in the ED but there is disagreement amongst doctors for two different treatment approaches: 1) conservative treatment where drugs are given to slow the heart rate, blood thinner pills given to prevent stroke, and the patient is sent home with ongoing AF/AFL; or 2) aggressive treatment where doctors put the patient's heart rhythm back to a regular rhythm with either drugs or electrical shock in the ED. We have completed two studies to prepare for this project and both showed that doctors use a wide variety of treatment approaches in Canadian EDs because the best approach is not clear. There is a need for better research. The overall goal will be to gather information about current Canadian ED treatment practices and outcomes for patients with RAFF and to design future studies. We will study seven specific objectives: 1) ED treatment approaches (drugs, electrical shock, blood thinners); 2) outcomes in the ED; 3) outcomes in the 45 days after leaving the ED; 4) quality of life and severity of symptoms; 5) health care resource use; 6) which treatments led to the best outcomes; 7) design future studies. We plan to study 1,000 patients with RAFF at 7 large EDs over a period of 24 months. We will collect information from: 1) hospital, emergency, and coroner records; 2) patient symptom and quality of life questionnaires; 3) telephone interviews. We will then analyze the results to to see which treatments appear to lead to better and safer outcomes for patients. Our results will be used to design future studies and to develop guidelines that can be used by doctors in our EDs. All this will lead to better health, outcomes, & quality of life for patients with RAFF