CLINICAL AUDIT ON ACUTE MANAGEMENT OF ATRIAL FIBRILLATION IN LINE WITH NICE AND ESC GUIDELINES

Atrial fibrillation (AF) is the most common cardiac arrhythmia and a major contributor to cardiovascular morbidity and mortality in UK. It is estimated that around 1.7 million people in the UK have been diagnosed with atrial fibrillation, but a significant proportion of them are not treated effectively. Adherence to guideline-based management is essential for optimising rate and rhythm control, as well as reducing thromboembolic risk and healthcare cost. This audit aimed to assess compliance with the National Institute for Health and Care Excellence (NICE) and European Society of Cardiology (ESC) guidelines in managing AF at Epsom and St Helier University Hospitals NHS Trust.

A retrospective audit was conducted including patients aged ≥18 years who presented with AF with Rapid Ventricular Response (RVR) (heart rate >110 bpm at rest). Of 93 patients reviewed, 46 met the inclusion criteria. Data were analysed regarding demographics, diagnosis status, CHA₂DS₂-VASc score, rate control medications, and anticoagulation prescription.

The mean CHA₂DS₂-VASc score was 3.3. Identified areas of non-compliance included concurrent use of bisoprolol and diltiazem, failure to titrate monotherapy to the maximum tolerated dose before introducing a second agent, and inconsistent documentation regarding anticoagulation decisions. Recognition of AF was satisfactory; however, improvements are needed in rate control management, thromboembolic risk assessment, and record-keeping.

In conclusion, this audit highlights the need for better adherence to AF management guidelines. Implementation of a standardised local protocol based on NICE and ESC guidelines will ensure safe, effective, and consistent care, while reducing hospital length of stay and overall healthcare costs. Furthermore, such a protocol will aid resident doctors in making consistent evidence-based decisions, particularly during out-of-hours periods when senior support may be limited and when admitting new patients. Enhanced clinician education is recommended to further improve practice and patient outcomes.