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Clinical Trial
. 2016 Jan 25;5(1):e002950.
doi: 10.1161/JAHA.115.002950.

An Integrated Management Approach to Atrial Fibrillation

Lindsey Carter  1 , Martin Gardner  1 , Kirk Magee  2 , Ann Fearon  1 , Inna Morgulis  1 , Steve Doucette  3 , John L Sapp  1 , Chris Gray  1 , Amir Abdelwahab  1 , Ratika Parkash  1
Affiliations
Clinical Trial

An Integrated Management Approach to Atrial Fibrillation

Lindsey Carter et al. J Am Heart Assoc. .

Abstract

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia resulting in mortality and morbidity. Gaps in oral anticoagulation and education of patients regarding AF have been identified as areas that require improvement.

Methods and results: A before-and-after study of 433 patients with newly diagnosed AF in the 3 emergency departments in Nova Scotia from January 1, 2011 until January 31, 2014 was performed. The "before" phase underwent the usual-care pathway for AF management; the "after" phase was enrolled in a nurse-run, physician-supervised AF clinic. The primary outcome was a composite of death, cardiovascular hospitalization, and AF-related emergency department visits. A propensity analysis was performed to account for differences in baseline characteristics.

Results: A total of 185 patients were enrolled into the usual-care group, and 228 patients were enrolled in the AF clinic group. The mean age was 64±15 years and 44% were women. In a propensity-matched analysis, the primary outcome occurred in 44 (26.2%) patients in the usual-care group and 29 (17.3%) patients in the AF clinic group (odds ratio 0.71; 95% CI [0.59, 1]; P=0.049) at 12 months. Prescription of oral anticoagulation was increased in the CHADS2 ≥2 group (88.4% in the AF clinic versus 58.5% in the usual-care group, P<0.01).

Conclusions: Adoption of this integrated management approach for the burgeoning population of AF may provide an overall benefit to cardiovascular morbidity and mortality.

Keywords: atrial fibrillation; quality and outcomes.

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Figures

Figure 1
Figure 1
Study flow. AF indicates atrial fibrillation.
Figure 2
Figure 2
Integrated management approach to AF care. AF indicates atrial fibrillation; ED, emergency department; OAC, oral anticoagulation.
Figure 3
Figure 3
Guideline adherence. The gray bars indicate the percentage of patients assessed for each variable by the usual‐care group; the black bars indicate the additional percentage of patients assessed by the AF clinic group. 95% CI are indicated on each bar (*P<0.0001). AF indicates atrial fibrillation.
Figure 4
Figure 4
Prescription of oral anticoagulation in the matched groups. The blue bars represent the AF clinic, the red bars the usual‐care group. 95% CI are indicated on each bar (*P<0.01). AF indicates atrial fibrillation.
See this image and copyright information in PMC

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