Rapid Clinical Updates: Atrial Fibrillation Occurring During Acute Hospitalization-Slides

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This presentation, "Atrial Fibrillation Occurring During Acute Hospitalization: Updates for the Hospitalist," provides a comprehensive review of atrial fibrillation (AF) identified or first managed during acute illness or hospitalization. Acute AF is increasingly common, reflecting the aging population, and occurs across diverse medical and surgical settings, including cardiac and non-cardiac surgeries, critical illness, and conditions such as COVID-19 and acute myocardial infarction.<br /><br />Key points highlight that acute AF is associated with increased hospital length of stay, morbidity, mortality, and high rates of recurrence post-discharge—recurrence rates ranging approximately 39%-76% depending on context (e.g., cardiac surgery vs non-cardiac surgery or medical illness). Detection is improved with continuous inpatient ECG monitoring, which shows higher incidence rates compared to intermittent methods.<br /><br />Management begins by assessing hemodynamic stability. Hemodynamically unstable patients require immediate electrical cardioversion. For stable patients, a nuanced approach balances rate control versus rhythm control, considering symptoms, patient tolerance, feasibility of anticoagulation, and underlying illness. Notably, rhythm control with early or delayed cardioversion shows similar outcomes in recent-onset, symptomatic AF. Anticoagulation decisions depend on individual thromboembolic risk, as risk may vary by AF duration and patient risk profiles (CHA2DS2-Vasc score), especially in the first 48 hours of AF onset.<br /><br />Specific trials in post-operative AF after cardiac surgery suggest comparable outcomes between rate and rhythm control strategies. Ongoing randomized controlled trials are investigating anticoagulation timing and strategies in non-cardiac surgery and stroke related to AF.<br /><br />The presentation emphasizes the importance of education, counseling, long-term follow-up, and management of modifiable risk factors after hospitalization due to the high risk of AF recurrence. Overall, the approach to acute AF during hospitalization involves careful triage, individualized therapy, and coordinated transition of care to optimize outcomes.<br /><br />References include recent American Heart Association scientific statements and key randomized trials underpinning current practice.

Keywords

Atrial Fibrillation

Acute Hospitalization

Hospitalist

ECG Monitoring

Hemodynamic Stability

Rate Control

Rhythm Control

Anticoagulation

Postoperative AF

AF Recurrence