- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05468281
RAFF5 Proposal: Improve the Quality and Safety of Patients Seen in the Emergency Department for Acute Atrial Fibrillation and Flutter (RAFF5)
RAFF5 Proposal: Project to Improve the Quality and Safety of the Immediate and Subsequent Care of Patients Seen in the Emergency Department With Acute Atrial Fibrillation and Flutter
Acute atrial fibrillation (AF) and flutter (AFL) are the most common arrhythmias requiring management in the emergency department (ED). They are characterized by sudden onset of a rapid heart rate which may be irregular (AF) or regular (AFL). Our focus is on episodes of acute AF or AFL which are usually less than 48 hours in duration and are highly symptomatic, requiring rapid treatment in the ED. Management guidelines for acute AF/AFL have changed substantially in recent years with several recent revisions published by the Canadian Cardiovascular Society (CCS) and the Canadian Association of Emergency Physicians (CAEP). The 2021 CAEP Acute Atrial Fibrillation/Flutter Best Practices Checklist (CAEP Checklist) was very recently published to assist ED physicians in Canada and elsewhere manage patients who present to the ED with acute AF/AFL (Figure 1).
The overall goal of this project is to improve the quality and safety of the immediate and subsequent care of patients seen in the ED with acute AF and AFL by implementing the principles of the CAEP Checklist at both The Ottawa Hospital (TOH) EDs and by working with TOH cardiologists to provide rapid cardiology follow-up processes for patients discharged from the ED. The Investigators propose a before-after cohort study using an interrupted time series design to evaluate implementation involving 720 patients at the two TOH EDs over a 24-month period.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Ontario
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Ottawa, Ontario, Canada, K1Y 4E9
- Ottawa Hospital Research Institute
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- include all eligible patient visits to the participating EDs during the study period regardless of how they are managed.
- include stable patients aged 18 and over,
- presenting with an episode of acute AF or AFL of at least 3 hours duration,
- where symptoms require ED management by rhythm or rate control.
Exclusion Criteria:
The study will exclude patients who have any of:
- permanent AF;
- deemed unstable and required immediate electrical cardioversion; or
- primary presentation was for another condition rather than arrhythmia.
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
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Before Period
The before period (12 months) serves as the control period prior to implementation; data will be collected by health records review.
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After Period
The after period (12 months) will be when patients are prospectively enrolled, and outcomes assessed.
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. Our strategies will include a) selection of local physician champions from the ED and cardiology; b) discussion of the goals of the study with the local physician groups; c) formal introduction of the CAEP Checklist to the physicians and nurses by means of presentations at staff meetings, emails, and an online video; d) development of an action plan to address local barriers to implementation; e) creation of a free smartphone application; f) regular reminders; and g) and distribution of charts of site compliance.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Improve the quality and safety of ED management of AF and AFL
Time Frame: 14 day
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the quality and safety of ED management based upon the CAEP Checklist management.
best practices.
The study team will use a score sheet which will identify specific managements for AF and AFL that are 1) optimal; 2) suboptimal; 3) unsafe.
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14 day
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Use of cardioversion (chemical or electrical) in the ED
Time Frame: Duration of the ED visit, approximately 4-12 hours.
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Duration of the ED visit, approximately 4-12 hours.
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use of rate control and the final heart rate at disposition
Time Frame: Duration of the ED visit, approximately 4-12 hours.
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Duration of the ED visit, approximately 4-12 hours.
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prescription of OAC on discharge
Time Frame: Duration of the ED visit, approximately 4-12 hours.
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Whether or not they were given an outpatient prescription for oral anticoagulants in accordance with the 2021 CAEP Checklist
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Duration of the ED visit, approximately 4-12 hours.
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consultations done in the ED by cardiology
Time Frame: Duration of the ED visit, approximately 4-12 hours.
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Whether or not the patient had an (unnecessary) consultation done in the ED by cardiology
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Duration of the ED visit, approximately 4-12 hours.
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Adverse events attributable to medical management
Time Frame: Duration of the ED visit, approximately 4-12 hours.
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adverse events including: i) conduction problems; ii) dysrhythmias; iii) hypotension requiring treatment; iv) respiratory events; f) admission to a hospital unit; and g) use of the rapid referral process.
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Duration of the ED visit, approximately 4-12 hours.
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Collaborators and Investigators
Investigators
- Principal Investigator: Ian Stiell, MD, Ottawa Hospital Research Institute
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 3875
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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