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Quality Improvement Topics

AI Filter Improves Positive Predictive Value of Atrial Fibrillation Detection by an Implantable Loop Recorder

Journal Articles: Journal article outlining a study to determine whether incorporation of a 2-part AI filter can improve the positive predictive value (PPV) of implantable loop recorder (ILR)-detected AFib episodes.


AFib Risk Factor Report Card: Risk factors for Atrial Fibrillation

Checklists: Self-evaluation tool for patients to use in their management of diagnosed AFib. Includes additional resources and a place for notes.


AFib Nurse Navigator Responsibilities

Workflows: List of proposed responsibilities for an AFib Nurse Navigator at an AFib Center.


Atrial Fibrillation Center of Excellence Appointment Tree

Education: Patient/Caregiver: Decision making support tool for patients to use when presenting with atrial fibrillation.


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.


Sleep Apnoea and AF: Where Do We Stand? Practical Advice for Clinicians

Guidelines/Clinical Documents: AF is the most common sustained arrhythmia encountered in clinical practice. Among the largest contributing factors to the rapid increase in the incidence of AF are aging and obesity within the global population. Obstructive sleep apnoea (OSA) is a risk factor for AF that is clearly linked to obesity. Guidelines have advocated interrogation for clinical signs of OSA in all AF patients. The aim of this article is to provide practical advice for clinicians seeking to manage patients with AF and OSA. The authors discuss questionnaires to screen for OSA, various types of tests available for the diagnosis of OSA and data to assess the impact of treatment of OSA after various treatment options in AF patients. Finally, they outline the many areas that warrant further investigation in this patient population.


Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation

Journal Articles: Catheter-based pulmonary vein isolation is an effective treatment for paroxysmal atrial fibrillation. Pulsed field ablation, which delivers microsecond high-voltage electrical fields, may limit damage to tissues outside the myocardium. The efficacy and safety of pulsed field ablation as compared with conventional thermal ablation is not known.


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.


Development of a Care Pathway for Atrial Fibrillation Patients in the Emergency Department

Care 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.


AF Action Plan

Education – Patient/Caregiver: Use this guide to help you tell your doctors or nurse about changes in your symptoms; Recognizing your AF symptoms will help you better manage your health; When you notice your symptoms early and take action, you are less likely to have to go to the hospital for treatment