We recommend hospital admission for highly symptomatic patients with decompensated heart failure or myocardial ischemia. (Recommendation Strong, Quality Low)<br /><br />We suggest limiting hospital admission to highly symptomatic patients in whom adequate rate control cannot be achieved. (Recommendation Conditional, Quality Low)<br /><br /><b>Values and preferences: </b> This recommendation places a high value on the need for monitoring of the response to therapy and its reassessment, as well as ancillary investigation and treatment not available in the ED in patients with complex medical conditions associated with AF/AFL. A lower value is placed on the attendant costs of admission to hospital in patients with complex medical conditions associated with AF/AFL.