34 * A one-stop-shop: a nurse led atrial fibrilation and DC cardioversion service

Abstract

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia and in addition to atrial flutter, these conditions are associated with adverse mortality and morbidity. They are an extremely costly public health problem, with hospitalization as the primary cost driver. Direct current cardioversion (DCCV) remains an effective treatment method to restore sinus rhythm (SR), however, the likely success of DCCV depends on the duration of AF. Consequently, any reduction in waiting times for DCCV has obvious benefits.Nurse-led multidisciplinary heart failure clinics have been shown to improve clinical outcomes. The establishment of an entirely nurse led service, which accepts new community referrals, performs DCCV and then follows patients up has not been widely trialed. Methods: In 2010 Dorset County Hospital established an entirely nurse led AF service. Referrals were accepted directly from the community in order reduce waiting times. On the day of the DCCV, past and present clotting was reviewed. The patient was anesthetised and DCCV was attempted. The result was recorded and patients were followed up at one month and six months. Complications were also logged. Results: Between 5th January 2010 and 28th April 2014, 402 patients were assessed and underwent DCCV. Complete follow up was available on 308. A full retrospective analysis was performed on all patients with a complete dataset. Conclusions: Our nurse led atrial fibrillation service continues to see and treat hundreds of patients with AF. They are independently able to select and perform DCCV with a complication rate similar to that achieved in clinician led services. AF is a progressive disease and expediting appointment times through the use of a nurse led service allows patients to be seen more rapidly. The majority of our patients who were in sinus rhythm at one month post DCCV remained in sinus at six months. This highlights one of the main successes of the nurse led approach; the close follow up afforded to patients who undergo DCCV which would be difficult to match in a physician led service. | No. of patients | 308 | |:---------------------------------------------------------- | ----------- | | Age (years) | 66.9 | | LA Dimension (cm) | 4.45 | | Time from referral to appointment (Days) | 36.2 | | Waiting time for patients eligible to undergo DCCV (Weeks) | 2.8 | | Sinus rhythm: After DCCV | 281 (91.2%) | | Sinus rhythm: 1 month | 136 (44.1%) | | Sinus rhythm: 6 Months | 118 (38.3%) | | Complications | 6 (1.9%) | | Bradycardia requiring PPM | 5 (1.6%) | | CVA | 1 (0.3%) | Table 1 Results of nurse led AF/DCCV service