Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
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 NICE CKS. 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 NICE CKS. 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) NICE CKS.
- 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 NICE CKS. This also applies if they have a suspected or confirmed pre-excitation syndrome, such as Wolff-Parkinson-White syndrome or another accessory pathway syndrome NICE CKS.
- 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 NICE CKS. Referral is also indicated for stable AF and heart failure thought to be primarily caused by AF NICE CKS. If a person has suspected paroxysmal AF and there is any uncertainty about management, a cardiology referral is appropriate NICE CKS. Additionally, refer if the person has AF and pre-existing or newly diagnosed structural heart disease, such as valvular heart disease or cardiomyopathy NICE CKS. 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 NICE NG196.