OUTCOMES OF AN ATRIAL FIBRILLATION PATIENT NAVIGATION DEMONSTRATION PROJECT

Abstract

Atrial fibrillation (AF) is growing in prevalence and is associated with substantial health care utilization. Prompt anticoagulation (OAC), rate and rhythm control is critical in preventing sequelae of AF. Connecting patients to secondary prevention (exercise, weight loss) through cardiac rehabilitation (CR) programs is also proven to decrease AF symptoms and recurrence. A January/February 2015 review of 60 consecutive patients presenting to the emergency department (ED) with a primary diagnosis of AF showed prolonged follow-up times and limited uptake of appropriate anticoagulation, likely secondary to concerns from ED physicians regarding lack of follow-up care. In March 2018, the AF navigation project was initiated to improve process of care through expedited telephone counseling by the AF navigator and subsequent care plan generation by the navigator and cardiologist, with best practice recommendations sent to family physicians. Referrals to specialty care and CR were made as needed. Here, the demonstration project results are compared to the 2015 review and a January/February 2018 review of 56 consecutive patients. For results, see Figure #1. To date, 129 patients have been referred to AF navigation. First telephone contact occurred, on average, in 2.4±1.8 days. Wait times (in days) to 1st in-person follow up have decreased from 26±36 in 2015 and 24±49 in Jan/Feb 2018 (n = 22) to 11±15 (p = 0.004). Only 4 (3%) AF navigation patients had a wait time greater than 31 days to their first follow-up appointment compared to 15 (25%) in 2015 (p < 0.05). ED prescribing of OAC occurred in 23% of AF navigation patients versus 0% in 2015 and 12% in Jan/ Feb 2018 (p = 0.005). 33% of AF navigation patients were started on OAC in follow up versus 17% of 2015 patients (p = < 0.05). For AF navigation patients with new onset AF, rate control was started by the ED in 44%, compared to 58% in 2015 and 71% in Jan/Feb 2018. 48% of AF navigation patients have accepted a referral to CR. A dedicated AF navigator reduces wait time to first in-person follow up for patients with AF, improves overall rates of anticoagulation and offers uptake into a secondary prevention program. Further analysis of health care utilization and outcomes of CR interventions is ongoing.