Atrial Fibrillation / flutter

Red flags

Consider immediate referral of patients with any of the following:

Ventricular tachyarrhythmias are potentially more serious as they can rapidly compromise cardiac output. These arrhythmias are:

Ventricular tachycardia
Torsade de Pointes
Ventricular fibrillation

A small number of patients in AF/SVT may present as significantly compromised.

Concerning symptoms

Syncope
Severe dizziness
Ongoing chest pain
Increasing dyspnoea

Concerning signs

Ventricular rate >150bpm
Hypotension (systolic <90mmHg)
Clinical heart failure
A family history of sudden cardiac death

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

New atrial fibrillation/flutter without Red flags
Recurrent paroxysmal atrial fibrillation / flutter
Atrial fibrillation with signs of heart failure or reduced LV function that does not require presentation to Emergency

Category 2

Appointment within 90 days is desirable

Chronic atrial fibrillation requiring management review (e.g. rate control, anticoagulation)

Category 3

Appointment within 365 days is desirable

No Category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

Not all patients have to be seen by a cardiologist if the general practitioner is comfortable caring for the patient.
In patients with new onset atrial arrhythmias (<48 hours), consider a fast track approach via telephone contact with the nearest cardiology service for consideration of earlier cardioversion to minimize the burden of atrial arrhythmia.
Refer to HealthPathways for assessment and management information if available

Referral requirements

A referral may be rejected without the following information.

Essential Referral Information

General referral information
Details of relevant signs and symptoms
Details of all treatments offered and efficacy
Past medical history and comorbidities
Family history of cardiac disease or sudden cardiac death
FBC, ELFTs, TSH
All available ECGs (including ECG showing arrhythmia)

Additional Referral Information (Useful for processing the referral)

Other investigations (if available) eg echocardiogram report, CXR report, holter monitor report, sleep study report
Coagulation studies, fasting lipid results, magnesium results
CHADS2 VASC score
Any investigations relevant to any co-morbidities
History of smoking, alcohol intake and drug use (including recreational drugs)

Out of catchment!

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Reason for Referral (essential)

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can’t order, or the patient can’t afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Clinical Information (essential)

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient’s Demographic Details (essential)

Full name (including aliases)
Date of birth
Residential and postal address
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details (essential)

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature

Other Information (where relevant)

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Send referral

Hotline: 1300 364 938

Fax: 1300 364 952

Electronic: eReferral system

Mail: Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034

Health pathways

Access to Health Pathways is free for clinicians in Metro North Brisbane.

For login details email:
healthpathways@brisbanenorthphn.org.au

Locations

Resources

Specialists list