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Atrial fibrillation (AF) is a commonly treated cardiac arrhythmia that is associated with an irregularly irregular ventricular rhythm and absence of a distinct P wave (Kumar, 2022). AF is usually classified by the duration and length of episodes. Paroxysmal AF terminates spontaneously or within intervention within seven days of onset (Kumar, 2022). Persistent AF fails to correct itself within seven days and often requires pharmacologic or electrical cardioversion to restore sinus rhythm (Kumar, 2022). Long-standing persistent AF lasts for more than 12 months, whereas permanent AF is when rhythm control strategy is terminated with a joint decision by the patient and clinician (Kumar, 2022). The most common symptoms of AF include palpitations, tachycardia, fatigue, weakness, dizziness, lightheadedness, reduced exertion capacity, and dyspnea (Kumar, 2022). 

History and examination for AF should include onset, possible precipitating factors, frequency or duration, severity of symptoms, characteristics, and previous medical records of any arrhythmias (Kumar, 2022). A framework that is used by many providers with AF patients is the ABC pathway. The A is considered for anticoagulation, B is for better symptom management, and C is for cardiovascular risk factor or comorbid disease assessment (Kumar, 2022). First line drug choices should include a long-term anticoagulant to prevent thromboembolism as well as a calcium channel blocker. Working in the emergency department, I do see patients with AF come in and states that their primary care provider placed them on metoprolol, which is a beta blocker. Many patients with new onset on AF are given an IV dose of diltiazem in an emergency setting, which often is effective. 

The CHADS scoring system is used by many providers to calculate a patient’s risk of having a stroke secondary to AF (Cunha, 2022). Patients are assigned points based on their risk factors for stroke. Many times, oral anticoagulant treatment to prevent strokes is based on this score. CHADS stands for Congestive heart failure, hypertension, Age 75 years or older, diabetes mellitus, and stroke (Cunha, 2022). All these risk factors are worth one point, except for the stroke which is wort two points (Cunha, 2022). Treating long-term AF is an important and crucial responsibility of the primary care provider or cardiologist. Many of these patients end up in the emergency department with the need for admission. If not treated correctly, admissions occur and raise healthcare costs as well as increase safety risks. 

 

Cunha, J. P. (2022). What Does CHADS Score Mean? emedicinehealth.com. Retrieved December 28, 2022, from https://emedicinehealth.com.

Kumar, K. (2022). Atrial Fibrillation: Overview and Management of New-Onset Atrial Fibrillation. UpToDate. 

SCIENCE
HEALTH SCIENCE
NURSING
NURS 6050

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