Rapid-access arrhythmia care as an integrated model: A RE-AIM guided systematic review

OBJECTIVES: To synthesize clinical and operational evidence for rapid-access arrhythmia care (RAAC), identifying implementation enablers and barriers using Consolidated Framework for Implementation Research (CFIR)- Expert Recommendations for Implementing Change (ERIC) and RE-AIM frameworks, and propose a reproducible workflow to support emergency department (ED) diversion and accelerated outpatient care. STUDY DESIGN: We conducted a RE-AIM and CFIR-ERIC-guided systematic narrative review of rapid-access arrhythmia care models. METHODS: We searched MEDLINE, Embase, and CINAHL from inception to October 10, 2025. Sixteen programs across the United Kingdom, Europe, Australia, Canada, and the United States were included after applying pre-specified eligibility criteria. Data were extracted on care models, clinical outcomes, and implementation determinants using a structured RE-AIM template, with CFIR-ERIC mapping used to identify actionable strategies. Risk of bias was assessed using RoB 2 (randomized trials) and ROBINS-I (non-randomized studies). RESULTS: RAACs improved time to specialist assessment and reduced ED revisits and hospital admissions, amongst other effects. Most non-randomized studies had a moderate risk of bias, and these outcomes should be interpreted as directional rather than definitive. Key CFIR enablers included structured triage, EMR integration, leadership support, and multidisciplinary staffing. Common barriers included workforce fragility, diagnostic bottlenecks, digital and health literacy gaps, and limited long-term funding. Adoption was higher where inner-setting governance and outer-setting policy alignment were strong; maintenance was weakest where programs lacked formal integration into cardiac service networks. CONCLUSIONS: RAACs are feasible across diverse health-system contexts when supported by disciplined implementation. We propose a six-step acute workflow-Reach, Intake, Rapid Access, Multidisciplinary Workflow, Follow-up, and Maintenance-to guide implementation.