Emergency And Rapid Arrhythmia Doctors And Patients Survey Research

PART Ⅰ:Investigation of the tachyarrhythmia management in emergency doctorsObjective To investigate the emergency physicians’ knowledge on emergency tachyarrhythmia,and to explore the way to improve management.Methods We conducted a questionnaire survey between January and September in 2016 in 3 emergency departments in Beijing.The questions in the survey included the basic information of the hospital,doctors and patients,the status of diagnosis and treatment,and the way to improve their knowledge.Results From the 3 centers a total of 126 questionnaires were collected,of which 56(44.0%)were from a tertiary referral center,24(19.0%)from a secondary referral center,and 46(36.5%)from a specialized center.Thirty-five point four per cent doctors could treat tachyarrhythmia independently.Twenty-five point four per cent of the patient family would accept electrical cardioversion if the patients had refractory but hemodynamically stable arrhythmias.In patients with atrial fibrillation without anticoagulation 60.3%of the physicians would consider anticoagulation immediately.The top three drugs that the doctors are most familiar were amiodarone,atropine and esmolol,whereas procainamide,Ibutilide and sotalol were in the most unfamiliar list.Sixty-seven point five per cent of the physicians had enough knowledge about amiodarone usage.For the question of a patient with previous myocardial infarction and stable monomorphic ventricular tachycardia treated with adequate doses(initial loading dose followed by maintenance infusion)of intravenous amiodarone electrical cardioversion was considered in 39(31.0%)answers,continuous intravenous amiodarone was the answer by 28(22.2%),and only in 11(8.7%)the answer was referring to the higher level hospitals.The main reasons for the departments which could not carry out standardized treatment of tachyarrhythmia were lack of knowledge or skills,and the concerning medical disputes by complications resulted from too much aggressive treatment.The main sources of knowledge for doctors were guidelines,textbook and department routine.Training courses and guidelines learning were considered as the proper ways for knowledge improvement.Conclusion Our study reflected the current situation in the management of emergency tachyarrhythmia in different level hospitals and indicated that less than four out of ten physicians could deal with tachyarrhythmia independently.Amiodarone,atropine and esmolol were widely used by physicians in emergency department.Lack of knowledge and skills and concern of complications impacted negatively in standard management.Guidelines and consensus training are effective ways to improve the standard clinical practice.PART Ⅱ:Current status of tachyarrhythmia management in emergency departmentsObjective To investigate the current condition of treatment and outcome of patients with tachyarrhythmia in emergency departments.Methods From January to September,2016,a total of 250 patients with tachyarrhythmia treated in emergency departments from three representative hospitals in Beijing were included in the study.Patients characteristics at baseline,information about tachyarrhythmia type,intravenous drug therapy and prognosis were collected.For atrial fibrillation or atrial flutter patients we also conducted a survey about anticoagulationResults A total of 250 patients were enrolled in this study,with an average age of 64 years.There were 127 males(50.8%)and 123 females(49.2%).Comorbidities included hypertension(54.0%),coronary heart disease(37.2%),stroke or TIA(11.6%),valvular heart disease(11.6%)and cardiomyopathy(7.2%),and 49.2%of participants had previous atrial fibrillation or atrial flutter.Fifty-four point four per cent patients were with organic heart diseases.Ninety-two per cent of the tachycardia were hemodynamically stable during the episode.Among the arrhythmias,the most common type was atrial fibrillation(68.8%),and the rest were supraventricular tachycardia(16.4%),ventricular tachycardia(9.2%),atrial flutter(8.4%),atrial tachycardia(4.6%)and premature ventricular contraction(2%).The most commonly used drug for supraventricular tachycardia was propafenone(60.4%).Amiodarone was widely used in atrial and ventricular arrhythmias.After receiving the treatment,arrhythmia termination occurred in 56%patients,the improvement of arrhythmia in 40%,and 10%of patients remained unchanged or died.In patients with atrial fibrillation or flutter,there was no significant difference for amiodarone using percentage in structural heart disease patients or normal heart structure patients;but in patients with ventricular tachycardia or wide QRS complex,amiodarone was used significantly higher in structural heart disease patients than normal heart structure patients(P=0.005).In emergency room,the amount of anticoagulation in patients with non-valvular atrial fibrillation or flutter was 107(67.3%),and the amount of oral anticoagulant in these patients was only 25(15.7%).Conclusion Our survey included the patients from three emergency departments,and half of the participants had organic heart diseases.Nearly six out of ten tachyarrhythmia terminated after the management of physicians.Atrial fibrillation was the most common tachyarrhythmia in emergency department,and intravenous amiodarone was widely used in clinical practice.Most practice was consistent with the current guidelines recommendation but there is room for improving in drug selection and AF anticoagulation.