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Specialized Atrial Fibrillation Clinic Improves Quality Metrics
Study Questions:
Is an atrial fibrillation (AF)–specific clinic associated with improved adherence to American College of Cardiology (ACC)/American Heart Association (AHA) clinical performance and quality measures for adults with AF or atrial flutter?
Methods:
This was a retrospective study comparing adherence to ACC/AHA measures for patients who presented to the emergency department for AF. Follow-up was in a typical outpatient appointment or a specialized AF transitions clinic run by an advanced practice provider and supervised by a cardiologist. Screening and treatment for common AF risk factors was also assessed.
Results:
There were 160 patients in the intervention group and 78 patients in the control group. Patients referred to the specialized clinic were more likely to have stroke risk assessed and documented (99% vs. 26%; p < 0.01); be prescribed appropriate anticoagulation (97% vs. 88%; p = 0.03); and be screened for comorbidities such as tobacco use (100% vs. 14%; p < 0.01), alcohol use (92% vs. 60%; p < 0.01), and obstructive sleep apnea (90% vs. 13%; p < 0.01) and less likely to be prescribed an inappropriate combination of anticoagulant and antiplatelet medications (1% vs. 9%; p < 0.01).
Conclusions:
An AF specialized clinic was associated with improved adherence to ACC/AHA clinical performance and quality measures for adult patients with AF.
Perspective:
A specialized AF clinic is associated with improved rates of several important quality and performance measures for AF management compared with the standard of care. There were significant differences in appropriately prescribed anticoagulation, screening for sleep apnea, and counseling for alcohol and tobacco use. Given the high prevalence of the comorbidities and risk factors, and their association with AF, it is likely that interventions such as this one, may significantly improve the quality of care patients receive. Of note, the specialized AF clinic visits usually took place within 48-72 hours, while the control cohort was seen in a primary care cardiology clinic within 45 days. It is possible that there may be additional benefits with interventions prescribed early when the patient’s attention is most keen.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Sleep Apnea
Keywords: Alcohol Drinking, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Emergency Service, Hospital, Platelet Aggregation Inhibitors, Risk Factors, Secondary Prevention, Sleep Apnea, Obstructive, Standard of Care, Stroke, Tobacco Use
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