Point-of-Care Ultrasound Assessment of Left Ventricular Function in Rapid Atrial Fibrillation or Flutter Patients in the Emergency Department

Abstract

Objective: The aim of this thesis is to evaluate the utilization of point-of-care ultrasound (POCUS) for left ventricular function (LVF) assessment by emergency physicians for the diagnosis and management of heart failure in rapid atrial fibrillation or flutter. Methods: A national survey of emergency physicians explored the integration and perceived barriers related to POCUS use in rapid atrial fibrillation or flutter. Subsequently, a health records review at The Ottawa Hospital ED studied diagnostic agreement of POCUS LVF assessment between ED physicians, cardiologists, and ED POCUS expert. Secondary outcomes were also analyzed regarding rapid atrial fibrillation or flutter management. Results: A fair level of agreement between cardiologists and ED physicians (k= 0.34 CI 95% 0.10-0.58) and moderate agreement was found between cardiologists and ED POCUS expert physician (kappa = 0.63 (CI 95% 0.43-0.82). A higher proportion of rapid atrial fibrillation/flutter patients with ED-performed POCUS were admitted to hospital (40% vs 19%, p<0.0001) and rate controlled with beta blocker (38% vs 24%, p=0.009) or digoxin (14% vs 5%, p=0.007). Conclusion: The utilization of POCUS in the rapid atrial fibrillation/flutter patients can help guide diagnosis and management of heart failure in the ED.