Heterogeneity in the role of emergency physicians and treatment of acute atrial fibrillation in emergency departments: results of the International Atrial Fibrillation Background (AFiB) Study

The consept of emergency departments (EDs) with specialized teams of emergency physicians originated in the United Kingdom and the United States during the 1970s and was expanded across most European countries in the twenty-first century. Among the various cardiac arrhythmias encountered in EDs, atrial fibrillation (AF) is the most prevalent, contributing to ED congestion. Existing guidelines offer multiple treatment options for acute-onset AF occurring within 48 hours. The aim of The Atrial Fibrillation Background Study is to evaluate treatment strategies, practices and the role of emergency physicians in managing acute-onset AF in Western medical tradition across Europe, the United States and China (Hong Kong). The data for this nonexperimental survey were collected through a questionnaire administered to the medical director or a senior physician at each of the 12 participating EDs. We obtained information regarding the total number of physicians employed in these EDs, their respective specialties, and the patient caseloads they managed. Additionally, we gathered data on the diagnostic and treatment protocols employed for atrial fibrillation (AF). In the investigated EDs in Hong Kong, the United Kingdom and the United States, patients were treated by emergency physicians. Comparatively, many European EDs primarily relied on physicians with traditional medical specialties. Diagnostic methods employed for acute AF ranged from point-of-care testing to comprehensive laboratory panels and echocardiography. In terms of AF treatment, rate control was the preferred approach in Hong Kong and the USA EDs, while rhythm control was preferred in European settings. Regarding rhythm control, there were considerable variations in preferences between pharmacological and electrical cardioversion methods. Findings from the AFiB Study highlight the growing significance of emergency physicians in the management of acute AF, as well as the divergent treatment approaches for acute AF observed in EDs between Europe and the United States.