Telehealth Clinics May Safely Manage Low-Risk Atrial Fibrillation Patients: Study
Australia: A pilot study published in the BMJ journal Heart suggests that selected low-risk patients with acute atrial fibrillation (AF) could be safely managed in the community using telehealth and rapid-access clinics, potentially avoiding emergency department visits. The model appeared feasible, ensured faster specialist input, and reduced hospital burden, though larger studies are needed to confirm long-term safety and scalability.
The STAY (Safe Treatment of Atrial Fibrillation in the CommunitY) pilot, led by Jocasta Ball and colleagues from Monash University, tested whether low-risk AF cases could be managed outside hospital settings through an integrated pathway involving paramedics, cardiologists, and virtual care.
Adults aged ≥18 years presenting with acute AF were first assessed by paramedics using clinical evaluation and ECG. Eligibility was confirmed by cardiologist review, and only low-risk patients—without hemodynamic instability or recent bleeding risk—were included. Enrolled patients received early treatment when indicated and were routed to telehealth consultations or rapid-access AF clinics instead of emergency department transfer.
The following were the key findings:
- Out of 573 patients with atrial fibrillation assessed, 445 were classified as low risk.
- A total of 57 patients were enrolled in the STAY community-based care pathway.
- Paramedics administered metoprolol in just over 50% of cases.
- Rivaroxaban was given in approximately 40% of patients, with no immediate safety concerns reported.
- Patients were subsequently managed through video-based telehealth consultations or dedicated AF clinics.
- The average time to initial specialist assessment was just over one day.
- The average wait time for AF clinic review was around three days.
- A total of 41 patients received virtual telehealth consultations.
- 55 patients attended outpatient atrial fibrillation clinics.
- No deaths were reported within 30 days of follow-up.
- Only three patients (around 5%) required hospital admission during the 30-day follow-up period.
- Overall, most low-risk patients were successfully managed in the community without need for hospital escalation.
The study suggests that a structured, community-based model for managing atrial fibrillation can reduce emergency department dependence while maintaining safety in carefully selected low-risk patients. The STAY pathway highlights the value of integrating paramedic assessment, telehealth consultations, and rapid-access specialist care to streamline acute AF management.
However, the authors noted that these findings are based on a pilot study with a limited sample size. They emphasized the need for larger, well-controlled trials to confirm clinical effectiveness, evaluate cost-effectiveness, and assess feasibility for broader implementation across diverse healthcare systems.
The researchers stated that the STAY model shows promise for safely managing selected low-risk patients with acute atrial fibrillation outside hospital settings, but further evidence is needed before it can be adopted into routine clinical practice.
Reference:
Ball J, Nehme Z, Wong G, et alSafe treatment of atrial fibrillation in the community (STAY): a pilot study of community-based care for low-risk patients with acute atrial fibrillation. Heart Published Online First: 14 May 2026. doi: 10.1136/heartjnl-2025-327605
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