Atrial Fibrillation/Flutter

Availability

North South North West Statewide

Pre-referral work-up

History

All referrals should comply with the Referral Standards and must include:

  • Heart rate
  • Frequency of symptoms
  • Assessment of thrombo-embolic risk (CHADS2 or CHADS-VASC score)
  • Associated symptoms - angina, SOB
  • Current and past medications and efficacy
  • Cardiac risk factors
  • Family history of cardiac disease or sudden cardiac death

Tests

  • FBE
  • U&Es, Creatinine
  • Thyroid function
  • ECG - particularly those demonstrating arrhythmia

Interim/GP management

To refer a patient with this condition, please see the Cardiology clinic page for the full referral process and templates.

Additional information which may be useful for triage:

  • Any investigations relevant to any co-morbidities
  • Other investigations (if available) e.g. echocardiogram report, CXR report, holter monitor report, sleep study report
  • History of smoking, alcohol intake and drug use (including recreational drugs)
  • Coagulation studies, magnesium, fasting lipid results

Interim management advice for Atrial Fibrillation (AF) can be found on the Health Pathways website.

For more information please see the Tasmanian Health Pathways website.

Emergency

Acute symptomatic AF
Signs of TIA or stroke

Urgent / category 1

  • New atrial fibrillation/flutter without concerning features:
    • haemodynamic instability
    • shortness of breath
    • chest pain
    • syncope/pre syncope/dizziness
    • known Wolff-Parkinson-White
    • neurological deficit indicative of TIA/stroke
  • Recurrent paroxysmal atrial fibrillation / flutter

Semi-urgent / category 2

Difficulties with anti-coagulation management
Symptomatic paroxysmal AF

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Additional Information

Article - Initial Management of Cardiac Arrhythmias

Emergency:

Proceed to Emergency Department (ED).
LGH ED Reception  – Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED* – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED* – Phone: (03) 6493 6351 Fax: (03) 6464 1926
RHH ED Reception – Phone: (03) 6166 6100  Fax: (03) 6173 0489

Advice for medical practitioners can be given by the Medical Officer In Charge (MOIC) - see HealthPathways Tasmania for contact information.
*MCH and NWRH MOICs request GPs call them prior to referring a patient to ensure the patient is being sent appropriately to a safe destination.

Urgent:

Urgent referrals should be accompanied by a phone call to the Consultant/Registrar to organise urgent review and the referral must be faxed.

We will endeavour to see these patients within one week, or sooner if clinically indicated.

Semi-urgent:

We will endeavour to see these patients within four weeks

Routine:

Next available appointment usually within eight weeks