383 A new atrial fibrillation clinic in vancouver: Treatment decisions and patient satisfaction during the first 9 months

Abstract

(EP),nursepractitioners (NP), registerednursesandpharmacists.The study describes SPH AFC’s initial experience in implementing CCS wait times and management guidelines. METHODS: Prospective data were collected on all patients referred to the AFC for assessment of referral, patient demographics, baseline clinical presentation and patterns of interventions. RESULTS: From November 2009 till April 2011, 980 patients were referred to AFC with a median of 59 (range 29-106) per month. The consultation wait time was 35 days (median), which was reduced from 198 days (median) in the preceding year. Every month, 35 new patients (median) attended group education sessions. The NP followed 27 patients (median) and the AFC conducted 337 (median) patient telephone calls per month to optimize management. The median age of referred patients was 61 years (range 22-88); 69% were male. Most patients (84.2%) lived within a 130 km radius of Vancouver, while 8.8% travelled from northern BC and 6.2% from BC interior region. The indications for referral were AF (84.5%), AF with atrial flutter (AFL) (11.7%) and AFL (3.8%). The presenting CHADS2 score was 0 41.3%, 1 31.9%, 2 18.0%, 3 7.5% and 4 1.3%. The CCS-SAF scale was Class I 18.8%, II 46.7%,III 32.6%andIV 1.9%,reflectingahighlysymptomatic population. Rate control therapy was instituted for 31%. In the rhythm control group, 17.2% received propafenone, 18.0% dronedarone, 18.5% sotalol and 17.7% amiodarone. In the past year, 308 procedureswereperformed(63DCcardioversions,196LAablations, 15 AV node ablations, 22 right sided AFL ablations, 6 SVT and 6 pacemaker implants), and 146 patients were discharged to referring centres. An AFC patient satisfaction survey demonstrated satisfaction scoreof19/20 (median)with86%reporting improvedorunchanged symptoms. CONCLUSION: The SPH AFC is a high volume provincial referral centre with streamlined access to tertiary electrophysiology resources. The program’s interdisciplinary teamwork has succeeded in optimizing AF management resources, meeting recommended CCS guidelines and achieving excellent patient satisfaction.