General / Comprehensive Management

Patient Centered Infographic on Lifestyle Management for Atrial Fibrillation

While the new guidelines provide excellent lifestyle changes (backed by evidence) for mitigation of atrial fibrillation, in clinic visits practitioners are often rushed for time, patients can feel scolded instead…

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Living With AFib Patient Guide

A comprehensive patient education booklet with key information regarding AFib treatment, pathophysiology, and risk factor modification to empower patients to live well with AFib. This unique booklet includes chronic conditions…

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AF Agile Pathway – Ambulatory

AF Agile Pathway – Ambulatory

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Utility and limitations of long-term monitoring of atrial fibrillation using an implantable loop recorder

Journal Articles: Atrial fibrillation (AF) is the most common cardiac arrhythmia diagnosed and treated in the world. The treatment of patients’ symptoms as well as the prevention of stroke and heart failure is dependent on accurate detection and characterization of AF. A variety of electrocardiographic (ECG) monitoring techniques are being used for these purposes. However, these intermittent ECG monitoring techniques have been shown to underdiagnose AF events while having limited ability to characterize AF burden and density. Continuous long-term implantable loop recorder (ILR)–based ECG monitoring has been designed to overcome these limitations. This technology is being increasingly used to diagnose episodes of AF in high-risk patients and to improve characterization of AF episodes in patients with known AF. This review aims to review the potential clinical utility of ILR-based ECG monitoring while highlighting some inherent limitations of the current technology. An understanding of these limitations is important when considering the use of ILR-based ECG monitoring and clinical decision making based on the information being stored within these devices.

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AFib Toolkit: CHA2DS2-VASc and Your Risk of Stroke

Education – Patient/Caregiver: CHA2DS2-VASc and Your Risk of Stroke

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ED AF <48h Protocol

Order Sets: ED AF <48h Protocol

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ED AF >48h/Unknown Duration Protocol

Order Sets: ED AF >48h/Unknown Duration Protocol

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Venous Vascular Closure System Versus Manual Compression Following Multiple Access Electrophysiology Procedures – The AMBULATE Trial

Journal Articles: OBJECTIVES This study compared the efficacy and safety of the VASCADE MVP Venous Vascular Closure System (VVCS) device (Cardiva Medical, Santa Clara, California) to manual compression (MC) for closing multiple access sites after catheter-based electrophysiology procedures. BACKGROUND The The VASCADE MVP VVCS is designed to provide earlier ambulatory hemostasis than MC after catheter-based procedures. METHODS The AMBULATE (A Randomized, Multi-center Trial to Compare Cardiva Mid-Bore (VASCADE MVP) VVCS to Manual Compression in Closure of Multiple Femoral Venous Access Sites in 6 – 12 Fr Sheath Sizes) trial was a multicenter, randomized trial of device closure versus MC in patients who underwent ablation. Outcomes included time to ambulation (TTA), total post-procedure time (TPPT), time to discharge eligibility (TTDe), time to hemostasis (TTH), 30-day major and minor complications, pain medication usage, and patient-reported outcomes. RESULTS A total of 204 patients at 13 sites were randomized to the device arm (100 patients; 369 access sites) or the MC arm (104 patients; 382 access sites). Baseline characteristics were similar between groups. Mean TTA, TPPT, TTDe, and TTH were substantially lower in the device arm (respective decreases of 54%, 54%, 52%, and 55%; all p < 0.0001). Opioid use was reduced by 58% (p ¼ 0.001). There were no major access site complications. Incidence of minor complications was 1.0% for the device arm and 2.4% for the MC arm (p ¼ 0.45). Patient satisfaction scores with duration of and comfort during bedrest were 63% and 36% higher in device group (both p < 0.0001). Satisfaction with bedrest pain was 25% higher (p ¼ 0.001) for the device overall, and 40% higher (p ¼ 0.002) for patients with a previous ablation. CONCLUSIONS Use of the closure device for multiple access ablation procedures resulted in significant reductions in TTA, TPPT, TTH, TTDe, and opioid use, with increased patient satisfaction and no increase in complications. (A Randomized, Multi-center Trial to Compare Cardiva Mid-Bore VVCS to Manual Compression in Closure of Multiple Femoral Venous Access Sites in 6 - 12 Fr Sheath Sizes [AMBULATE]; NCT03193021)

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AF Center and HRS QI Provider Inservice

Education – Clinical: Provider education presentation including AFib and anticoagulation overview, rate control care pathway, suggested AFib patient education, and ED algorithm.

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Implementation of an Atrial Fibrillation Decision Aid Care Pathway in the Emergency Department Reduces Atrial Fibrillation Hospitalizations

Care Pathways/CDS: Decision aid to guide disposition of AFib patients in the ED, specifically created for use by ED providers.

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