AP-453071-4 NOVEL COMANAGEMENT-BASED COMMUNITY VIRTUAL ATRIAL FIBRILLATION CENTER (AFC)

Abstract

Delays in the management of AFib, and specifically delays in patient access to advanced therapies, can make antiarrhythmic interventions less successful and more complicated. A virtual atrial fibrillation center (AFC) has the potential to provide high-quality and expedited specialty electrophysiology care to individual patients that present to the hospital with atrial fibrillation. Utilizing a template designed around a patient comanagement strategy, we describe our experience with a novel AFC in a non-academic hospital setting. We describe the creation of a multi-disciplinary team of physicians and APPs in Emergency Medicine, Internal Medicine and Cardiac Electrophysiology. We then describe an admission criteria algorithm (Figure 1) that enables state-of-the-art, coordinated, and guideline-directed therapy for patients with atrial arrhythmias. Over a 1-year period, we tracked several quality metrics which were decided upon prior to deployment. Objective patient admission criteria to the AFC were established and included assessment of hemodynamics, serum biomarkers levels, EKG interpretation. These criteria were supplemented with clinical assessment at the time of presentation. Quality metrics for program assessment were determined prior to deployment and included time to EP consult, CHA2DS2-VASc assessment, time to outpatient EP follow-up, and time from presentation to cardiac ablation. A total of 247 patients were admitted to the AFC over a 1-year period following the admission algorithm. Time to EP consult was less than 24 hours (7.9hrs +/- 7.6 hrs.). 100% of patients underwent CHA2DS2-VASc assessment. Time to outpatient follow-up was less than 14 days (10.8 days +/- 4.5 days). Time from index presentation to advanced therapy (cardiac ablation) was reduced from 134 days to 60.5 days. Utilizing a multidisciplinary management team was an effective strategy to assist in the management of Afib patients that met the criteria for admission to the AFC. Results from our AFC model show expedited access to advanced therapy, including Afib ablation, and excellent compliance with guideline-directed medical therapy based on CHA2DS2-VASc assessment. These results also translated into a reduction in hospital readmissions for Afib and a decreased length of hospital stay. This specific model will allow for future growth of the AFC, including expansion of the criteria template to include other atrial arrhythmias.