Impact of the RACE 7 ACWAS trial on patient behaviour, referral and treatment strategies at the emergency department: patient perspectives
Authors: Van Der Velden RMJ , Pluymaekers NAHA , Dudink EAMP , Timmermans TAFM , Hermans ANL , Gawalko M , Verhaert DVM , Betz K , Luermans JGLM , Crijns HJGM , Linz D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In the Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See (RACE 7 ACWAS) trial, a delayed cardioversion approach was compared to early cardioversion. Based on the results of this trial, the delayed cardioversion approach has been added to the European Society of Cardiology guidelines for atrial fibrillation (AF) as a strategy for the acute management of patients with recent-onset AF episodes.

Purpose
The aim of this study was to evaluate the impact of participation in the RACE 7 ACWAS trial, in combination with education on the delayed cardioversion approach, on the behaviour of patients regarding their recent-onset AF episodes.

Methods
Patients who were enrolled in the RACE 7 ACWAS trial in our centre and who gave their consent to be approached for future research projects were asked to complete a questionnaire, asking about AF recurrences and related treatment after their participation in the RACE 7 ACWAS trial.

Results
Of the 148 patients enrolled in the RACE 7 ACWAS trial in our centre, 130 patients were eligible for this study. Of these patients, 16 refused participation, 25 could not be reached and 16 did not return the questionnaire. Seventy-three patients (mean age 69, 64.4% men, 50.7% delayed cardioversion group) completed the questionnaire and were included in the current analysis. Forty-nine patients (67.1%) experienced AF recurrences after the trial. Of the patients with AF recurrences, 23 patients (46%) indicated that since their participation in the trial they have been waiting longer for spontaneous conversion to occur, i.e. 13 patients (26%) wait longer before contacting the emergency department (ED) and 10 patients (20%) wait as long as it takes for spontaneous conversion to occur. Twenty-five patients (51.0%) had been to the ED because of AF at least one time after their participation in the RACE 7 ACWAS trial. Eleven patients (45.8%) who contacted the ED were advised to wait at home a while longer before visiting the ED. In 13 patients (52%) a delayed cardioversion approach at the ED was applied at least once. Eleven patients experiencing recurrences (22.9%) indicated that ED visits had been avoided because the ED advised them telephonically to await spontaneous conversion longer (Figure 1). There were no significant differences between patients who were in the early cardioversion group compared to patients who were in the delayed cardioversion group (Table 1).

Conclusion
The RACE 7 ACWAS trial appears to have impacted the behaviour of approximately half of the included patients, who indicated that following participation in the trial they were more likely to await spontaneous conversion. Health care professionals at the ED adopted a delayed cardioversion strategy in half of all cases. In about 1 in every 4-5 patients, an ED visit was avoided because patients were telephonically advised to wait longer.