References

Bridgwater: Class Professional Publishing; 2013

Keeping our finger on the pulse.Bristol: AFA; 2010

The AF Report. Atrial fibrillation: preventing a stroke crisis.Bristol: AFA/ACE; 2011

Banner D Overview of pathophysiology and management of AF. Br J Card Nurs. 2013; 8:(5)240-9

Bennett DH, 7th edn. London: Hodder Arnold; 2006

Bloe C Atrial fibrillation and primary stroke prevention. Nurs Stand. 2011; 26:(6)49-57

Boriani G, Diemberger I, Biffi M, Martignani C, Branzi A Pharmacological cardioversion of atrial fibrillation. Drugs. 2004; 64:(24)2471-62

Boriani G, Diemberger I, Martignani C, Biffi M, Branzi A The epidemiological burden of atrial fibrillation: a challenge for clinicians and healthcare systems. Eur Heart J. 2006; 27:(8)893-4

National Audit of Percutaneous Coronary Interventional Procedures.London: BCIS; 2011

Brüggenjürgen B, Kohler S, Ezzat N, Reinhold T, Willich SN Cost effectiveness of antiarrhythmic medications in patients suffering from atrial fibrillation. Pharmacoeconomics. 2013; 31:(3)195-213

Camm AJ, Kirchof P, Lip GYH Guidelines for the management of atrial fibrillation. Eur Heart J. 2010; 31:(19)2369-429

Conen D, Osswalds S, Albert CM Epidemiology of atrial fibrillation. Swiss Med Wkly. 2009; 139:(25–26)346-52

Conti A, Del Taglia B, Mariannini Y Management of patients with acute atrial fibrillation in the ED. Am J Emerg Med. 2009; 28:(8)903-10

Cottrell C Atrial fibrillation part 1: pathophysiology. Practice Nursing. 2012; 23:(1)16-21

Cowan C, Healicon R, Robson I The use of anticoagulants in the management of atrial fibrillation among general practices in England. Heart. 2013; 99:(16)1166-72

Dagres N, Lewalter T, Lip GYH, Pison L, Proclemer A, Blomstrom-Lundqvist C Current practice of antiarrhythmic drug therapy for prevention of atrial fibrillation in Europe: the European Heart Rhythm Association survey. Europace. 2013; 15:(4)478-81

Davis RC, Hobbs R, Kenkre JE Prevalence of atrial fibrillation in the general population and in high-risk groups: the ECHOES study. Europace. 2012; 14:(11)1553-9

Davis LL Contemporary management of atrial fibrillation. J Nurse Pract. 2013; 9:(10)643-52

National Service Framework for Coronary Heart Disease. Chapter 8: Arrhythmias and Sudden Cardiac Death.London: DH; 2005

Gregory P JRCALC: advice or requirement?. Journal of Paramedic Practice. 2010; 2:(1)

Gubbins K UK Paramedic Rapid Sequence Intubation—is it viable?. Ambulance UK. 2007; 5:(7)17-25

Hart RG, Pearce LA, Aguilar MI Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007; 146:(12)857-67

Hobbs FD, Fitzmaurice DA, Mant J A randomised controlled trial and cost-effectiveness study of systemic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in people aged 65 and over. The SAFE study. Health Technol Assess. 2005; 9:(40)1-74

Holding S, Russell C, Tyndall K Treating and managing atrial fibrillation. Nurs Times. 2013; 109:(31–32)16-19

Kerr CR, Humphries KH, Talajic M Progression to chronic atrial fibrillation after the initial diagnosis of paroxysmal atrial fibrillation: results from the Canadian Registry of Atrial Fibrillation. Am Heart J. 2005; 149:(3)489-96

Levy S, Camm AJ, Saksena S International consensus on nomenclature and classification of atrial fibrillation. Europace. 2003; 5:(2)119-22

Lip GY, Hee FL Paroxysmal atrial fibrillation. QJM. 2001; 94:(12)665-78

Lip GY, Tse HF Management of atrial fibrillation. Lancet. 2007; 370:(9587)604-18

Lip GY, Watson T Atrial fibrillation (acute onset). Clin Evid. 2008; 5:(210)1-23

Naccarelli GV, Varker H, Lin J, Schulman KL Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol. 2009; 104:(11)1534-9

Nadarasa K, Williams MJ Single high oral dose amiodarone for cardioversion of recent onset atrial fibrillation. Heart Lung Circ. 2012; 21:(8)444-8

Emergency admissions to hospital: managing the demand.London: NAO; 2013

Atrial fibrillation: national clinical guideline for management in primary and secondary care.London: Royal College of Physicians; 2006

The management of atrial fibrillation.London: NICE; 2006

The management of atrial fibrillation.London: NICE; 2014

Commissioning for Stroke Prevention in Primary Care—The Role of Atrial Fibrillation.Leicester: NHS Improvement; 2009

Nottingham F Diagnosis and treatment of atrial fibrillation in the acute care setting. J Am Acad Nurse Prac. 2010; 22:(6)280-7

Padgett BE Management of patients with atrial fibrillation: diagnosis and treatment. Nurs Stand. 2012; 26:(22)47-56

Perrea DN, Ekmektzoglou KA, Vlachos IS A formula for the stratified selection of patients with paroxysmal atria fibrillation in the emergency setting. J Emerg Med. 2008; 40:(4)374-9

London: RCUK; 2010

Richards G An overview of atrial fibrillation. Nurs Stand. 2012; 26:(52)47-56

Rosiak M, Dziuba M, Chudzik M Risk factors for atrial fibrillation: not always severe heart disease, not always so ‘lonely’. Cardiol J. 2010; 17:(5)437-42

Salam AM Rate control versus rhythm control for the management of atrial fibrillation: the verdict of the AFFIRM trial. Expert Opin Investig Drugs. 2003; 12:(7)1231-7

Sanoski CA Clinical, economic and quality of life impact of atrial fibrillation. J Manag Care Pharm. 2009; 15:S4-9

Schoonderwoerd BA, Smit MD, Pen L, Van Gelder IC New risk factors for atrial fibrillation: causes of ‘not-so-lone’ atrial fibrillation. Europace. 2008; 10:(6)668-73

One million have heart condition that raises risk of stroke. 2014. http//www.theguardian.com/society/2014/jan/11/heart-atrial-fibrillation-stroke-risk (accessed 12 July 2014)

Singh BN, Singh SN, Reda DJ Amiodarone versus sotalol for atrial fibrillation. N Engl J Med. 2005; 352:(18)1861-72

Smith AM, Hardy PJ, Sandler DA, Cooke J Paramedic decision making: prehospital thrombolysis and beyond. Emerg Med J. 2011; 28:(8)700-702

Somasundaram K, Ball J Medical emergencies: atrial fibrillation and myocardial infarction. Anaesthesia. 2013; 68:81-101

Tuseth V, Jaatun HJ, Dickstein K Amiodarone infusion in the treatment of acute atrial fibrillation or flutter: high versus low dose treatment. Heart. 2005; 91:(7)964-5

Wallentin L, Yusuf S, Ezekowitz MD Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial. Lancet. 2010; 376:(9745)975-83

Wanahita N, Messerli FH, Bangalore S, Gami AS, Somers VK, Steinberg JS Atrial fibrillation and obesity: results of a meta-analysis. Am Heart J. 2008; 155:(2)310-15

Wattigney WA, Mensah GA, Croft JB Increasing trends in hospitalisation for atrial fibrillation in the United States 1985 through 1999: implications for primary prevention. Circulation. 2003; 108:(6)711-16

Westerby R, Cottrell C An update on atrial fibrillation. Practice Nurse. 2011; 41:(4)37-43

management
medications
long term conditions
prehospital

Potential use of amiodarone to treat new-onset AF in the pre-hospital setting

02 August 2014
Features
02 August 2014
Volume 6 · Issue 8

Abstract

Incidence of atrial fibrillation (AF) is high, it is the most prevalent arrhythmia in the UK, Europe and the USA (Naccarelli et al, 2009; Davis et al, 2012; Dagres et al, 2013) and is associated with significant morbidity, high risk of stroke and mortality (Cottrell, 2012). Clinical guidance from the National Collaborating Centre for Chronic Conditions (NCCCC) (2006) and the National Institute for Health and Care Excellence (NICE) (2006) supports clinicians working in primary and hospital-based emergency care, but not those working in pre-hospital care. Updated guidance from NICE (2014) highlights the importance of providing rapid, personalised, evidence-based care, yet does not provide any guidance for pre-hospital clinicians responding to emergency presentations of AF. Paramedics have knowledge and experience of identifying AF, possess antiarrhythmic, anticoagulant and anti-platelet medications as part of their formulary and possess the necessary skills for obtaining intravenous access.

This article reviews the national guidance and available best-evidence to provide safe treatment to patients presenting with new-onset AF and considers areas that merit further research.

Atrial fibrillation (AF) represents a major health challenge for society (Lip and Tse, 2007), affecting approximately 1.5% of the UK population (Wallentin et al, 2010). In the UK, in 2012–13 there were over 1 million people with the condition, up 21% from six years ago (Siddique, 2014). Across Europe, over 6 million people have this arrhythmia, and its prevalence is expected to grow significantly over the next 50 years (Camm et al, 2010). AF is a serious arrhythmia, associated with significant mortality and morbidity (Cottrell, 2012), and is more common in men than women (NCCCC, 2006). AF is responsible for prolonged hospital stays and high mortality rates (Somasundaram and Ball, 2013). Hospitalisations for AF total nearly 30% of acute admissions for all arrhythmias (Camm et al, 2010).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed

Register
Or continue by

Signing in with your registered email address

Amiodarone
Atrial fibrillation
New-onset
Paroxysmal
Pre-hospital
Scope of practice
Stroke