What criteria should I use to assess the need for referral to a cardiologist for a patient with atrial fibrillation?

When assessing the need for referral to a cardiologist for a patient with atrial fibrillation (AF), consider the following criteria, depending on the urgency of the situation:

• Emergency Hospital Admission: Arrange emergency hospital admission if the person has new-onset AF within the past 48 hours and is haemodynamically unstable ¹. This also applies if they have severe AF symptoms due to a rapid (more than 150 beats per minute) or very slow (less than 40 beats per minute) ventricular rate ¹. Other reasons for emergency admission include concomitant acute decompensated heart failure, a serious or life-threatening underlying cause or complication of AF (such as stroke or transient ischaemic attack), or an acute, potentially reversible trigger or intercurrent illness (e.g., pneumonia or thyrotoxicosis) ¹.
• Hospital Admission or Urgent Specialist Cardiology Advice: Arrange hospital admission or seek urgent specialist cardiology advice if the person has new-onset AF within the past 48 hours and is haemodynamically stable ¹. This also applies if they have a suspected or confirmed pre-excitation syndrome, such as Wolff-Parkinson-White syndrome or another accessory pathway syndrome ¹.
• Cardiology Referral or Specialist Cardiology Advice: Arrange cardiology referral or seek specialist cardiology advice if the person has AF of unknown duration or onset more than 48 hours ago, and there is any uncertainty about management ¹. Referral is also indicated for stable AF and heart failure thought to be primarily caused by AF ¹. If a person has suspected paroxysmal AF and there is any uncertainty about management, a cardiology referral is appropriate ¹. Additionally, refer if the person has AF and pre-existing or newly diagnosed structural heart disease, such as valvular heart disease or cardiomyopathy ¹. Prompt referral (within 4 weeks after failed treatment or recurrence after cardioversion) is necessary if treatment fails to control the symptoms of AF and more specialised management is needed ³.