Special Atrial-Fibrillation Clinics May Help Boost Quality of Care

By David Douglas

November 13, 2019

NEW YORK (Reuters Health) - After discharge from the emergency department, patients with atrial fibrillation (AF) assigned to a specialized clinic are much more likely to receive appropriate care, researchers have found.

"Our study helps to demonstrate the benefit of a collaborative care model in improving quality of atrial fibrillation care," Dr. Anil K. Gehi of the University of North Carolina at Chapel Hill told Reuters Health by email. "A clinical service designed to help transition patients from the setting of an acute AF exacerbation to a more long-term, comprehensive management plan provided significant benefit in several objective measures of quality."

There are significant gaps in care of patients with AF, including under-prescription of anticoagulation and treatment of AF risk factors, Dr. Gehi and colleagues note in JACC: Clinical Electrophysiology, online October 30.

To help address these deficiencies, the team previously developed a structured process for AF care. This linked the expertise of ED and cardiology practices with the introduction of clinical pharmacists. By coordinating treatment the aim was to reduce unnecessary hospital admissions while improving access to comprehensive AF care.

To assess the performance of the approach, the researchers reviewed data on160 patients who were referred to the specialized AF transition clinic. The clinic was staffed by a nurse practitioner or clinical pharmacist and supervised by a cardiologist or electrophysiologist.

These patients were compared with 78 historic controls who, before access to the transitions clinic was readily available, had been either admitted to the hospital or discharged from the ED with cardiologist or primary-care follow-up availability. The aim overall was to assess adherence to American College of Cardiology (ACC) and American Heart Association (AHA) clinical performance and quality measures.

Patients referred to the specialized clinic were significantly more likely to have stroke risk assessed and documented (99% vs. 26%) and be prescribed appropriate anticoagulation (97% vs. 88%).

There were similar findings for screening for co-morbidities such as tobacco use (100% vs. 14%), alcohol use (92% vs. 60%) and obstructive sleep apnea (90% vs. 13%). And patients at the specialized clinic were significantly less likely to be prescribed an inappropriate combination of anticoagulant and antiplatelet medications (1% vs. 9%).

The researchers conclude, "Comprehensive atrial fibrillation clinics may be a viable option to improve the comprehensive care of patients with atrial fibrillation."

SOURCE: https://bit.ly/2KdFOZB

JACC Clin Electrophysiol 2019.