社区内安全治疗心房颤动（STAY）：低危急性房颤患者社区管理的初步研究
STAY初步研究评估整合式社区照护模式对经急救医疗服务（EMS）就诊的低危急性房颤患者的可行性与安全性。2021年12月至2024年6月纳入57例患者，由急救人员给予美托洛尔和/或利伐沙班后转虚拟照护与快速房颤门诊，30天内无死亡、3例（5%）住院。
要点
- 低危急性房颤患者可经急救人员评估后直接转入社区照护，避免急诊转运。
- 急救人员给予美托洛尔（54%）和利伐沙班（40%）未见不良事件。
- 30天内无死亡，住院3例（5%），专科照护等待时间短。
核心结论
- 整合式社区照护对低危急性房颤患者可行，无需患者转运或急诊评估，专科照护获取迅速且后续住院不常见，未影响患者安全。
研究设计与样本
- STAY为初步研究，2021年12月至2024年6月纳入年龄≥18岁的低危急性房颤患者。
- 低危定义为无心肺功能受损和近期出血，由心内科医生在入组前确认。
主要发现
- 573例房颤患者中445例（78%）为低危适合STAY模式，57例（12%）被招募。
- 急救人员给予美托洛尔54%、利伐沙班40%，无不良事件。
- 41例接受虚拟视频远程会诊，55例就诊快速房颤门诊，平均等待3.1±2.6天；虚拟照护或门诊等待1.1±1.6天。
- 30天内无死亡，3例（5%）住院。
临床怎么用
- 对经急救人员评估为低危的急性房颤患者，可考虑社区照护路径替代急诊转运。
- 急救人员可在评估后给予美托洛尔和/或利伐沙班，并转虚拟照护或快速房颤门诊。
局限性
- 为初步研究，样本量小（57例），需进一步评估STAY模式大规模应用的可能性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: Atrial fibrillation (AF) is a major contributor to the Australian healthcare burden, requiring frequent use of emergency medical services (EMS) and hospitalisations. The Safe Treatment of Atrial Fibrillation in the CommunitY (STAY) pilot study aimed to assess the feasibility and safety of an integrated, community-based model of care for low-risk patients presenting to EMS with acute AF. METHODS: Between December 2021 and June 2024, we enrolled low-risk patients aged ≥18 years with acute AF. After paramedic clinical assessment and a 12-lead ECG, AF and low-risk status (defined as the absence of cardiorespiratory compromise and recent bleeding) were confirmed by a cardiologist prior to enrolment. Patients were treated with metoprolol and/or rivaroxaban where appropriate and transitioned to virtual care and rapid-access AF (AFX) clinics, avoiding transport to ED. Primary outcomes were time to definitive specialist care and hospital admission or death within 30 days. RESULTS: Of 573 patients with AF, 445 (78%) were at low risk and suitable for the STAY model of care; 57 (12%) were recruited. Paramedics administered metoprolol to 54% and rivaroxaban to 40% without adverse effects. 41 patients received virtual care video-telehealth consultations and 55 patients attended an AFX clinic with a mean wait time of 3.1±2.6 days. The wait for either virtual care or an AFX clinic was 1.1±1.6 days. At 30 days, there were no deaths, and hospital admission had occurred in three patients (5%). CONCLUSIONS: In our pilot study, integrated community-based care was feasible for managing low-risk patients with AF. There was no requirement for patient transport or ED evaluation; access to specialist care was rapid and subsequent hospitalisation was uncommon. Community-based care was implemented without impacting patient safety. The STAY model of care requires further assessment to assess its potential for application at scale to reduce the burden of AF and to provide streamlined community-based care.
引用
- Ball J, Nehme Z, Wong G, et al. Safe treatment of atrial fibrillation in the community (STAY): a pilot study of community-based care for low-risk patients with acute atrial fibrillation. Heart. 2026. PMID: 42135058. doi:10.1136/heartjnl-2025-327605
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。