General / Comprehensive Management
Education – Clinical: Provider education presentation including AFib and anticoagulation overview, rate control care pathway, suggested AFib patient education, and ED algorithm.
Read MoreCare Pathways/CDS: Decision aid to guide disposition of AFib patients in the ED, specifically created for use by ED providers.
Read MoreCare Pathways/CDS: Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence is continuously increasing in the United States, leading to a progressive rise in the number of disease-related emergency department (ED) visits and hospitalizations. Although optimal long-term outpatient management for AF is well defined, the guidelines for optimal ED management of acute AF episodes is less clear. Studies have demonstrated that discharging patients with AF from the ED after acute stabilization is both safe and cost effective; however, the majority of these patients in the United States and in our institution are admitted to the hospital. To improve care of these patients, we established a multidisciplinary collaboration to develop an evidence-based systematic approach for the treatment and management of AF in the ED, that led to the creation of the University of California—Cardioversion, Anticoagulation, Rate Control, Expedited Follow-up/Education Atrial Fibrillation Pathway. Our pathway focuses on the acute stabilization of AF, adherence to best practices for anticoagulation, and reduction in unnecessary admissions through discharge from the ED with expedited outpatient follow-up whenever safe. A novel aspect of our pathway is that it is primarily driven by the ED physicians, while other published protocols primarily involve consulting cardiologists to guide management in the ED. Our protocol is very pertinent considering the current trend toward increased AF prevalence in the United States, coupled with a need for widespread implementation of strategies aimed at improving management of these patients while safely reducing hospital admissions and the economic burden of AF.
Read MoreCare Pathways/CDS: Care pathway and decision support tool for use in the outpatient management of AFib patients. Includes when to consider early consultation, AV nodal blocking therapies, modifiable risk factors, and need for anti-coagulation.
Read MoreJournal Articles: OBJECTIVES: This study sought to assess whether an atrial fibrillation (AF)–specific clinic is associated with improved adherence to American College of Cardiology (ACC)/American Heart Association (AHA) clinical performance and quality measures for adults with AF or atrial flutter; BACKGROUND: There are significant gaps in care of patients with AF, including underprescription of anticoagulation and treatment of AF risk factors. An AF specialized clinic was developed to reduce admissions for AF but may also be associated with improved quality of care.; METHODS: This retrospective study compared adherence to ACC/AHA measures for patients who presented to the emergency department for AF between those discharged to a typical outpatient appointment and those discharged to a specialized AF transitions clinic run by an advanced practice provider and supervised by a cardiologist. Screening and treatment for common AF risk factors was also assessed; RESULTS: The study enrolled 78 patients into the control group and 160 patients into the intervention group. Patients referred to the specialized clinic were more likely to have stroke risk assessed and documented (99% vs. 26%; p < 0.01); be prescribed appropriate anticoagulation (97% vs. 88%; p ¼ 0.03); and be screened for comorbidities such as tobacco use (100% vs. 14%; p < 0.01), alcohol use (92% vs. 60%; p < 0.01), and obstructive sleep apnea (90% vs. 13%; p < 0.01) and less likely to be prescribed an inappropriate combination of anticoagulant and antiplatelet medications (1% vs. 9%; p < 0.01).; CONCLUSIONS: An AF specialized clinic was associated with improved adherence to ACC/AHA clinical performance and quality measures for adult patients with AF. (J Am Coll Cardiol EP 2020;6:45–52) © 2020 by the American College of Cardiology Foundation.
Read MoreCare Pathways/CDS: Decision support tool for clinicians to utilize after EKG confirms AFib or atrial flutter. Includes initial evaluation, AFib specifics, and decision options.
Read MoreCare Pathways/CDS: Clinical Pathway for Suspected AF
Read MoreCare Pathways/CDS: SOP for therapy options when treating AFib. Includes flow chart, decision trees, chart for AAD dosage, and risk factors/comorbidities.
Read MoreCare Pathways/CDS: Care pathway for clinicians to use when suspecting atrio-esophageal fistula in patients.
Read MoreCare Pathways/CDS: Clinical pathway for suspected atrial fibrillation.
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