'Safe treatment of atrial fibrillation in the community'

1. http://orcid.org/0000-0002-1512-4255Jocasta Ball1,2,3,4,
2. http://orcid.org/0000-0003-2432-1645Ziad Nehme1,2,
3. Geoffrey Wong5,
4. Julian Yeoh5,
5. Louise Brown5,
6. Lorelle Martin3,5,
7. Daniel Okyere2,
8. Emily Mahony2,
9. Jonathan M Kalman6,
10. http://orcid.org/0000-0001-5369-5844Peter Merrick Kistler1,3,
11. Dion Stub1,2,3,4,
12. Mark Horrigan1,5,7
    
    

 

Abstract

Background Atrial fibrillation (AF) is a major contributor to the Australian healthcare burden, requiring frequent use of emergency medical services (EMS) and hospitalisations. The Safe Treatment of Atrial Fibrillation in the CommunitY (STAY) pilot study aimed to assess the feasibility and safety of an integrated, community-based model of care for low-risk patients presenting to EMS with acute AF.

Methods Between December 2021 and June 2024, we enrolled low-risk patients aged ≥18 years with acute AF. After paramedic clinical assessment and a 12-lead ECG, AF and low-risk status (defined as the absence of cardiorespiratory compromise and recent bleeding) were confirmed by a cardiologist prior to enrolment. Patients were treated with metoprolol and/or rivaroxaban where appropriate and transitioned to virtual care and rapid-access AF (AFX) clinics, avoiding transport to ED. Primary outcomes were time to definitive specialist care and hospital admission or death within 30 days.

Results Of 573 patients with AF, 445 (78%) were at low risk and suitable for the STAY model of care; 57 (12%) were recruited. Paramedics administered metoprolol to 54% and rivaroxaban to 40% without adverse effects. 41 patients received virtual care video-telehealth consultations and 55 patients attended an AFX clinic with a mean wait time of 3.1±2.6 days. The wait for either virtual care or an AFX clinic was 1.1±1.6 days. At 30 days, there were no deaths, and hospital admission had occurred in three patients (5%).

Conclusions In our pilot study, integrated community-based care was feasible for managing low-risk patients with AF. There was no requirement for patient transport or ED evaluation; access to specialist care was rapid and subsequent hospitalisation was uncommon. Community-based care was implemented without impacting patient safety. The STAY model of care requires further assessment to assess its potential for application at scale to reduce the burden of AF and to provide streamlined community-based care.

https://heart.bmj.com/content/early/2026/05/13/heartjnl-2025-327605