Direct to an emergency department for:
- Recent onset atrial fibrillation with any of the following:
- haemodynamic instability
- shortness of breath
- chest pain
- heart failure
- current syncope or pre-syncope
- sustained heart rate > 150 beats per minute
- known Wolff-Parkinson-White syndrome.
Criteria for referral to public hospital specialist clinic services
- Recurrent paroxysmal atrial fibrillation.
- Atrial fibrillation where anticoagulation is contraindicated
- Atrial fibrillation with reduced left ventricular function or moderate valvular disease
- Atrial fibrillation that is unresponsive to medical management and that requires further advice on, or review of, the current management plan.
Information to be included in the referral
Information that must be provided
- Details of all relevant signs and symptoms
- Current and previous 12 lead electrocardiogram (ECG) tracings, particularly those demonstrating the arrhythmia
- Details of previous medical management including the course of treatment and outcome of treatment
- Current and complete medication history (including non-prescription medicines, herbs and supplements)
- Past medical history and comorbidities
- Liver function tests
- Urea and electrolyte results
- Full blood examination results
- Thyroid stimulating hormone (TSH) level.
Provide if available
- Any family history of cardiac disease or sudden cardiac death
- Results of other investigations (e.g. echocardiogram, chest x-ray, Holter monitor, sleep studies)
- International normalised ratio (INR) result
- CHA2DS2-VA risk score
- If the person has a limited life expectancy
- If the person identifies as an Aboriginal and Torres Strait Islander.
The Summary and referral information lists the information that should be included in a referral request.
The referral should note if the request is for a second or subsequent opinion.
Note: there are also cardiology statewide referral criteria for Palpitations.
Where appropriate and available the referral may be directed to an alternative specialist clinic or service.
Referral to a public hospital is not appropriate for
- Isolated event of atrial fibrillation that has resolved (e.g. post-infection).
- Patients that are stable (that is heart rate is stable and the patient is on anticoagulation) and not for further active management.
- Patients that are already under the care of a cardiologist.