A Multidisciplinary Atrial Fibrillation Clinic

Tran, Huyentran N.; Tafreshi, Javad; Hernandez, Elvin A.; Pai, Sudha M.; Torres, Vilma; Pai, Ramdas G.

doi:10.2174/1573403x11309010007

Cited by 8 publications

(17 citation statements)

References 20 publications

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“…AF specialty clinics, focusing on patient education and employing decision support software based on AF guidelines, have been evaluated in small observational and randomized studies with promising reductions in cardiovascular mortality, hospitalization, and stroke. (14,28) Additionally, these care models have been shown to be cost effective. (29) Point of care or pragmatic trials evaluating AF specialty clinics and novel care models for newly-diagnosed AF should be considered as a next step.…”

Section: Discussionmentioning

confidence: 99%

Treating Specialty and Outcomes in Newly Diagnosed Atrial Fibrillation

Perino

Fan

Schmitt

et al. 2017

Journal of the American College of Cardiology

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BACKGROUND Atrial fibrillation (AF) occurs in many clinical contexts and is diagnosed and treated by clinicians across many specialties, which has been associated with treatment variation. OBJECTIVES We evaluated the association of treating specialty with AF outcomes among patients with newly-diagnosed AF. METHODS Using complete data of the TREAT-AF (The Retrospective Evaluation and Assessment of Therapies in AF) study from the Veterans Health Administration, we identified patients with newly diagnosed, nonvalvular AF between 2004-2012 and at least one outpatient encounter with primary care or cardiology within 90 days of AF diagnosis. Cox proportional hazards regression was used to evaluate association between treating specialty and AF outcomes. RESULTS Among 184,161 patients with newly-diagnosed AF (age 70±11; 1.7% women; CHADS-VASc 2.6±1.7), 40% received cardiology care and 60% received primary care only. After adjustment for covariates, cardiology care was associated with reductions in stroke (HR 0.91, 95% CI 0.86-0.96, p <0.001) and death (HR 0.89; 95% CI 0.88-0.91; p <0.0001) and increases in AF/SVT (HR 1.38; 95% CI 1.35-1.42; p <0.0001) and MI (HR 1.03; 95% CI 1.00-1.05; p <0.04). The propensity matched cohort had similar results. In mediation analysis, oral anticoagulation (OAC) prescription within 90 days of diagnosis may have mediated reductions in stroke but did not mediate reductions in survival. CONCLUSIONS In patients with newly-diagnosed AF, cardiology care was associated with improved outcomes, potentially mediated by early OAC prescription. Although hypothesis-generating, these data warrant serious consideration and study of health care system interventions at the time of new AF diagnosis.

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Section: Discussionmentioning

confidence: 99%

Treating Specialty and Outcomes in Newly Diagnosed Atrial Fibrillation

Perino

Fan

Schmitt

et al. 2017

Journal of the American College of Cardiology

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“…Several studies have evaluated the effectiveness of care coordination or integrative care in reducing hospitalizations, stroke, and death [2, 30–32]. McDonald et al reported on the role that care coordination may play in implementing and maintaining appropriate OAC therapy in AF patients [33].…”

Section: Discussionmentioning

confidence: 99%

Impact of care coordination on oral anticoagulant therapy among patients with atrial fibrillation in routine clinical practice in Japan: a prospective, observational study

Ono

Akiyama

Suzuki³

et al. 2019

BMC Cardiovasc Disord

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BackgroundCare coordination between general practitioners (GPs) and cardiovascular specialists is expected to play a key role in establishing appropriate oral anticoagulant (OAC) treatment in atrial fibrillation (AF) patients. The aim of this study was to assess the impact of care coordination on oral anticoagulant therapy in the management of AF in Japan.MethodsThis study was a multi-center, single-arm, prospective cohort study with retrospective chart and claims data review for historical controls. The study included three study periods: a 12-month pre-campaign period; a 12-month campaign period for AF screening and care coordination; and a 3-month post-campaign period for follow-up of care coordination. During the campaign period, patients aged ≥65 years who attended participating GP clinics underwent opportunistic AF screening by GPs under the campaign. At the discretion of the GP, newly diagnosed AF patients after the screening were referred to a cardiovascular specialist for care coordination. To assess the impact of care coordination and evaluate the effects of the campaign, implementation of care coordination, antithrombotic therapies, and patient-reported outcomes were compared between patients with and without care coordination, and between patients during the pre-campaign and campaign periods.ResultsThere were 86 newly diagnosed AF patients during the pre-campaign period and 90 during the campaign period. The percentage of patients with care coordination increased from 3.5% (3/86) in the pre-campaign period to 14.4% (n = 13/90) during the campaign period. The percentage of patients who received OAC therapies, according to the definition from the Japanese AF medication guideline, increased from 55.8% (48/86) to 71.1% (64/90) during the campaign period regardless of care coordination. Younger patients were referred to cardiovascular specialists for care coordination. Implementation of OAC therapy did not differ between patients with and without care coordination. Adherence to OAC therapy was low regardless of care coordination.ConclusionsThis GP-targeted campaign was effective at raising awareness regarding the implementation of care coordination and appropriate OAC therapy at local clinical practices in Japan. Improvement of adherence to OAC therapy in elderly patients is a critical issue, and measures such as education programs targeted to patients and healthcare professionals should be undertaken.

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“…4 This is an area of possible improvement within integrated health-care systems as other institutions have shown almost 33% of hospitalizations are primarily due to atrial fibrillation. 5 The likelihood of dealing with anti-arrhythmics is high, and up to 93% of patients on amiodarone experience an adverse drug event. 1…”

Section: Introductionmentioning

confidence: 99%