A Multidisciplinary Atrial Fibrillation Clinic

Abstract

Background:Reports in the literature indicate that specialty clinics focusing on management of patients with specific chronic disorders have a significant positive impact on patient outcomes. Atrial fibrillation (AF), one of the most common forms of cardiac arrhythmia, affects millions of patients. Outcome data regarding the impact of managing patients with AF are limited. We established a specialty clinic focusing on management of patients with AF. The objective of our study was to evaluate the outcomes of treating AF patients in this clinic.Methods:A team consisting of electrophysiologists and pharmacists designed a specific plan for managing and educating patients. This plan consisted of evaluation, implementation of an individualized treatment plan, patient education, medication management, and follow-up care. We reviewed the outcomes of patients who had clinic visits between November 2011 and March 2012. The primary outcome was the incidence of AF-related hospitalizations and stroke. Results:Seventy one patients were included in the analysis. Out of 71 patients, we identified 17 (23.9%) patients who were hospitalized. Two of these 17 hospitalized patients had ischemic stroke events. Conclusion:When compared to published data in the existing literature, managing AF patients in specialty clinics reduces the incidence of AF-related hospitalizations and stroke.

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…W australijskiej RCT wykazano jednak tylko marginalny wpływ na zgony i nieplanowane hospitalizacje, gdy stosowano zintegrowaną opiekę ograniczoną do początkowego okresu leczenia, co być może podkreśla potrzebę długotrwałej integracji leczenia AF [332]. W 2 badaniach obserwacyjnych dotyczących zintegrowanego leczenia AF stwierdzono mniejszą częstość hospitalizacji [333,334], w 1 badaniu zaobserwowano mniej przypadków udaru mózgu [333], a w kolejnym nierandomizowanym badaniu wykazano trend w kierunku mniejszej częstości występowania złożonego punktu końcowego obejmującego zgony, hospitalizacje z przyczyn sercowo--naczyniowych oraz wizyty na oddziale pomocy doraźnej związane z AF [335]. Potrzeba większej liczby badań na ten temat, a zintegrowana opieka nad pacjentami z AF będzie prawdopodobnie wymagać różnych schematów postępowa-nia w różnych warunkach funkcjonowania opieki zdrowotnej.…”

The management of atrial fibrillation: An integrated team approach – insights of the 2016 European Society of Cardiology guidelines for the management of atrial fibrillation for nurses and allied health professionals

“…Integrated care in AF is a relatively novel concept, and evidence supporting the effectiveness of this approach is scarce. However, two observational studies on structured AF care demonstrated a reduction of hospitalisations, 21,22 as well as fewer strokes. 21 Also, a recent systematic review and meta-analysis identified three trials examining the effectiveness of integrated care in AF.…”

“…However, two observational studies on structured AF care demonstrated a reduction of hospitalisations, 21,22 as well as fewer strokes. 21 Also, a recent systematic review and meta-analysis identified three trials examining the effectiveness of integrated care in AF. 23 This demonstrated a significant reduction in all-cause mortality (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.32 to 0.80, P=0.003), as well as cardiovascular hospitalisations (OR 0.58, 95% CI 0.44 to 0.77, P=0.0002).…”

Structured management, Symptoms, Health-related Quality of Life and Alcohol in Patients with Atrial Fibrillation

“…In order to improve the care of patients with AF, different approaches in dedicated structured care models have been tested in recent years [53][54][55][56][57] . At the time of planning of the studies that constitute this thesis, no such study had been conducted.…”