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Complications and Prognosis
Screening and Prevention
Patients who have symptoms (ie, palpitations, chest pain, shortness of breath, diaphoresis, dizziness) require urgent evaluation in an emergency care setting r39
Patients who are hemodynamically unstable require urgent treatment in an emergency care setting, often with IV nodal blocking medication and, sometimes, urgent cardioversion
Patients who are hemodynamically stable with minimal or no symptoms may be managed as outpatients
Patients with new-onset atrial fibrillation who undergo elective electrocardioversion in the emergency department are sometimes admitted for monitoring; regional practices vary, and younger, healthier patients are often discharged home afterward if they are stable
Initiation (or dose escalation) of dofetilide for rhythm control requires inpatient evaluation in an ECG-monitored bed; some experts prefer a monitored admission for initiation of sotalol r40
Patients with uncontrolled comorbid conditions that precipitate or exacerbate atrial fibrillation (ie, COPD exacerbation, sepsis, heart failure, trauma) often require hospital admission r41
Patients who are highly symptomatic despite adequate treatment may require hospital admission r42
Treatment of atrial fibrillation is organized around 2 main issues:
Anticoagulation decisions are based on risk stratification
Symptom management (control of rate and rhythm)
Modification of lifestyle and management of cardiovascular risk factors to decrease burden of atrial fibrillation (secondary prevention) r3
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