069 Improving Atrial Fibrillation Outcomes Through an Interdisciplinary Atrial Fibrillation Clinic: Incidence of Cerebrovascular Events and Emergency Room Visits

Abstract

BackgroundAtrial fibrillation (AF) poses a significant burden for both patients and the health care system. Cerebrovascular events - strokes and transient ischemic attacks (TIA) - and Emergency Room visits are major resource-impacting factors adversely associated with AF. Interdisciplinary AF clinics (AFC) provide a means of providing rapid access and effective continuity of care to patients. The AFC at St. Paul's Hospital (SPH), Vancouver, BC has strived to deliver guideline-driven care to AF patients. We currently report our stroke and emergency room (ER) visit outcomes at the 2 year mark.MethodsProspective data were collected on all patients referred to the AFC for patient demographics, clinical presentation, management strategies and outcomes. Patient-reported strokes or TIAs were confirmed by consultation with a neurologist. ER visits were tallied based on self-reporting by patients at follow-up visits.ResultsFrom February 2010 to February 2012, 897 patients were seen. The majority of patients were male (68%), with a median age of 61 years. Symptom burden as rated by CCS-SAF score was 0/I in 25%, II in 47%, and III/IV in 28%. CHADS2 score was 0 in 39%, 1 in 35%, 2 in 18%, 3 in 7%, and 4/5 in 1%. Oral anticoagulation was achieved in 40% with CHADS2 ≥ 1 and 86% with CHADS2 ≥ 2. Warfarin was used in 44%, dabigatran in 7%, and antiplatelet therapy alone in 42%. There were 7 strokes and 5 TIAs, resulting in a 0.7%/year thromboembolism rate. 7 events occurred on warfarin (2 with a subtherapeutic INR), 2 on dabigatran, and 3 on aspirin. ER visits were required by 10% of patients/year, resulting in 378 total visits. 9% of patients required more than 1 ER visit over the 24 month period (Figure 1).ConclusionThe institution of a multidisciplinary AFC is associated with favourable clinical outcomes in our patient population. This includes a low incidence of thromboembolic events comparable with that seen in stringently-run randomised-controlled trials, largely due to aggressive use of guideline-driven antithrombotic therapy. In addition, ER visits were infrequent, with only a minority of individuals seeking medical attention in the ER. This may translate into significant cost-savings for the health care system. Further analyses will be required to assess the impact of AFCs in addressing other clinical outcomes and its cost-effectiveness. BackgroundAtrial fibrillation (AF) poses a significant burden for both patients and the health care system. Cerebrovascular events - strokes and transient ischemic attacks (TIA) - and Emergency Room visits are major resource-impacting factors adversely associated with AF. Interdisciplinary AF clinics (AFC) provide a means of providing rapid access and effective continuity of care to patients. The AFC at St. Paul's Hospital (SPH), Vancouver, BC has strived to deliver guideline-driven care to AF patients. We currently report our stroke and emergency room (ER) visit outcomes at the 2 year mark. Atrial fibrillation (AF) poses a significant burden for both patients and the health care system. Cerebrovascular events - strokes and transient ischemic attacks (TIA) - and Emergency Room visits are major resource-impacting factors adversely associated with AF. Interdisciplinary AF clinics (AFC) provide a means of providing rapid access and effective continuity of care to patients. The AFC at St. Paul's Hospital (SPH), Vancouver, BC has strived to deliver guideline-driven care to AF patients. We currently report our stroke and emergency room (ER) visit outcomes at the 2 year mark. MethodsProspective data were collected on all patients referred to the AFC for patient demographics, clinical presentation, management strategies and outcomes. Patient-reported strokes or TIAs were confirmed by consultation with a neurologist. ER visits were tallied based on self-reporting by patients at follow-up visits. Prospective data were collected on all patients referred to the AFC for patient demographics, clinical presentation, management strategies and outcomes. Patient-reported strokes or TIAs were confirmed by consultation with a neurologist. ER visits were tallied based on self-reporting by patients at follow-up visits. ResultsFrom February 2010 to February 2012, 897 patients were seen. The majority of patients were male (68%), with a median age of 61 years. Symptom burden as rated by CCS-SAF score was 0/I in 25%, II in 47%, and III/IV in 28%. CHADS2 score was 0 in 39%, 1 in 35%, 2 in 18%, 3 in 7%, and 4/5 in 1%. Oral anticoagulation was achieved in 40% with CHADS2 ≥ 1 and 86% with CHADS2 ≥ 2. Warfarin was used in 44%, dabigatran in 7%, and antiplatelet therapy alone in 42%. There were 7 strokes and 5 TIAs, resulting in a 0.7%/year thromboembolism rate. 7 events occurred on warfarin (2 with a subtherapeutic INR), 2 on dabigatran, and 3 on aspirin. ER visits were required by 10% of patients/year, resulting in 378 total visits. 9% of patients required more than 1 ER visit over the 24 month period (Figure 1). From February 2010 to February 2012, 897 patients were seen. The majority of patients were male (68%), with a median age of 61 years. Symptom burden as rated by CCS-SAF score was 0/I in 25%, II in 47%, and III/IV in 28%. CHADS2 score was 0 in 39%, 1 in 35%, 2 in 18%, 3 in 7%, and 4/5 in 1%. Oral anticoagulation was achieved in 40% with CHADS2 ≥ 1 and 86% with CHADS2 ≥ 2. Warfarin was used in 44%, dabigatran in 7%, and antiplatelet therapy alone in 42%. There were 7 strokes and 5 TIAs, resulting in a 0.7%/year thromboembolism rate. 7 events occurred on warfarin (2 with a subtherapeutic INR), 2 on dabigatran, and 3 on aspirin. ER visits were required by 10% of patients/year, resulting in 378 total visits. 9% of patients required more than 1 ER visit over the 24 month period (Figure 1). ConclusionThe institution of a multidisciplinary AFC is associated with favourable clinical outcomes in our patient population. This includes a low incidence of thromboembolic events comparable with that seen in stringently-run randomised-controlled trials, largely due to aggressive use of guideline-driven antithrombotic therapy. In addition, ER visits were infrequent, with only a minority of individuals seeking medical attention in the ER. This may translate into significant cost-savings for the health care system. Further analyses will be required to assess the impact of AFCs in addressing other clinical outcomes and its cost-effectiveness. The institution of a multidisciplinary AFC is associated with favourable clinical outcomes in our patient population. This includes a low incidence of thromboembolic events comparable with that seen in stringently-run randomised-controlled trials, largely due to aggressive use of guideline-driven antithrombotic therapy. In addition, ER visits were infrequent, with only a minority of individuals seeking medical attention in the ER. This may translate into significant cost-savings for the health care system. Further analyses will be required to assess the impact of AFCs in addressing other clinical outcomes and its cost-effectiveness.