UMEM Educational Pearls

Afib Clinical Decision Aid: AFFORD

- Atrial fibrillation (AF) affects ~34 million people worldwide; the hospital admission rates vary with frequencies of 81%, 62%, and 24% in the US, Australia, and Canada respectively.

- Lack of a reproducible and accurate risk stratification/decision aid likely contributes to variability in ED disposition.

- AFFORD (Atrial fibrillation and flutter outcome risk determination) was the 1st clinical decision aid (contains 17 variables) to predict 30-day adverse events in a prospective ED patient cohort with acute symptomatic AF.

- Vanderbilt University Medical Center's ED (2010-2013) derived and internal validated an ED based clinical decision aid for prediction of MACE within 30 days utilizing the AFFORD decision aid in hemodynamically stable patients whose AF reverted to sinus rhythm, either spontaneously or after cardioversion (pharmacologic or electrical), and those who are adequately rate controlled and candidates for outpatient management.

- Incorporating AFFORD with a shared decision model into ED practice may help identify patients at low risk and potentially reduce rate of hospitalizations. 


Barrett TW, Storrow AB, et al. The AFFORD Clinical Decision Aid to Identify Emergency Department Patients With Atrial Fibrillation at Low Risk for 30-Day Adverse Events. The American Journal of Cardiology Volume 115, Issue 6, Pages 763-770 (15 March 2015).

Barrett TW, Storrow AB, et al. Atrial fibrillation and flutter outcomes and risk determination (AFFORD): design and rationale. J Cardiol, 58 (2011), pp. 124–130.