Impact of the introduction of an integrated multi-professional pathway for atrial fibrillation on long-term outcomes. (14th October 2021)

• Record Type: Journal Article
• Authors: Aslam, S; Vickers, C; Veevers, W; Farrar, L; Hartley, L; Viswanathan, K
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Stroke in Atrial Fibrillation; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.0469
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: An integrated structured approach to atrial fibrillation (AF) management is recommended by ESC.1 However, limited data is available on its "real-world" impact on anticoagulation uptake and subsequent AF-related hospitalisation and stroke rates. Purpose: To evaluate the long-term impact of the introduction of a community-wide integrated AF service based in a secondary care hospital. Methods: In September 2017 we implemented a new integrated pathway for patients with newly diagnosed "symptomatic" atrial arrhythmias across two regions (population 450, 000) in England in collaboration with primary care. All patients were seen in a one-stop multi-professional clinic (Arrhythmia nurse and Electrophysiologist with ECG and echocardiogram) within 2 weeks. They underwent standardised screening for modifiable risk factors, counselling regarding diagnosis/ anticoagulation and received an individualised AF management plan as well as access to a nurse-led telephone helpline. We followed up the first 126 consecutive patients for a period of 12 months. Results: Baseline characteristics are shown in Table 1, showing a high incidence of modifiable risk factors (previously un-identified in the majority). After review in clinic, 30-day AF-related readmission rates to hospital were low (1.6%, n=2) as compared to historical local data (5.8%). This was sustained at 3 months (4.7%, n=6) and at 12 months (7.9%, n=10). 99% of 83 of eligible patients (CHA2DS2-VASc score of >2 with no major contra-indications) received oral anticoagulation. Over 12 months follow-up, rates of TIA/stroke was low (n=3, 2.4%). All-cause mortality was also low (n=1, 0.8%). NHS England region-wide data showed a marked reduction in percentage of total stroke admissions with history of AF not taking anticoagulation at stroke presentation in 2018/19 as compared to 2017/18 across our two regions; this was lower than the national average and the lowest within West Yorkshire (Figure 1). Conclusions: An integrated service for AF management implemented community-wide was associated with high uptake of oral anticoagulation among eligible patients and low rates of AF-related hospitalisations and all-cause mortality. Across the community, among stroke admissions with AF at presentation, a lower percentage of patients without anticoagulation was observed in comparison with previous years and neighbouring regions. Funding Acknowledgement: Type of funding sources: None.