Aim: To explore baseline demographics, prevalence of pre-existing AF, incidence of new AF and its management within a tertiary hospital ASU with proactive geriatric medicine input (Older Adult Surgical Inpatient Service)
Methods: Baseline data on older adults admitted to ASU, receiving proactive geriatric medicine input was collected from 1/5/2021 to 1/4/2022. Prospectively collected data on 874 presentations were retrospectively reviewed. Coded data on Hospital Acquired Complications identified incidence of new AF. Patients with pre-existing AF requiring emergency management were identified using Medical Emergency Team (MET) activation data. Electronic medical record review identified AF management.
Results: Average age of the study population was 80 years, average Clinical Frailty Scale (CFS) score was 4 and Charlson Co-morbidity Score (CCI) was 5.7. Twenty five percent (n=215) of older adults had pre-existing AF and 0.92% (n=8) developed new AF. Those with pre-existing AF also had hypertension (n=97, 45%), congestive cardiac failure (n=70, 33%) and diabetes mellitus (n=55, 26%). Acute surgical presentations included lower gastrointestinal bleeding (n=57, 26%), small bowel obstruction (n=42, 20%) and cholecystitis/ cholangitis (n=39, 18%). Four percent of patients (n=9) with pre-existing AF had MET activation for AF during their admission. Five received both electrolyte optimisation and metoprolol as initial management by the MET. Two patients experienced minor complications associated with management. All patients achieved rate control within 2-10 hours. For those with new AF (n=8), electrolyte optimisation and amiodarone were the most common initial management (n=3). Nil complications of management were recorded. Six patients reverted back to sinus rhythm.
Conclusions: One in 4 older adults presenting with acute general surgical pathology have pre-existing atrial fibrillation, 4% required management via MET. Less than 1% of older adults developed new AF during the admission, with nearly 40% of those managed via electrolyte optimisation and amiodarone by the MET.