Objective: The purpose of this audit was to describe and compare the referred population to a nurse-facilitated suspected arrhythmia clinic for the period July 2007 to July 2008 with the previous year’s audit data as reported by Lapper and Smallwood (2008); assessing the impact on service provision and use of resources. Method: Retrospective data were collected from all new referrals to a nurse-facilitated suspected arrhythmia clinic from July 2007 to July 2008. Results: 302 patients were referred to the nurse-facilitated suspected arrhythmia clinic. Referrals were predominantly female, aged between 17–92 years and mostly Caucasian. The most common symptom prompting referral was palpitations (60%), with ‘stress’ being the most common self-reported precipitating factor (20%). Cardiac monitoring was instituted in 73% of patients. Following investigation atrial fibrillation was identified in 31% of referred patients, paroxysmal supra-ventricular tachycardia 9%, atrial ectopy 7%, ventricular ectopy 13%, sinus rhythm with pauses (1%), with no arrhythmias identified in 38% of the cohort. Findings were not recorded in 1% of patients. Conclusions: The most striking feature of this review is the 57% increase in new patients referred suggesting that this clinic has become embedded in the cardiology appointments system and shows a willingness of referrers to use this avenue of referral. An impact on resources and practitioner role was noted. Despite the increase in referrals the number of arrhythmias detected was noted to be similar to the previous audit period. The need to evaluate clinic effectiveness is highlighted.
Objective: Specialist nursing services focused on delivering care to patients with a suspected arrhythmia are evolving. An audit was undertaken to characterize the population of patients referred to a nurse-facilitated suspected arrhythmia outpatient clinic during the fi rst year of its operation, to assess effectiveness of the clinic in identifying those requiring further treatment, organizational implications of such a clinic and to form a baseline against which future audits can be compared. Methods: Retrospective data were collected from all patients newly referred and assessed in a nurse-facilitated suspected arrhythmia from July 2006 to July 2007. Results: 192 patients were referred to this clinic. New referrals were predominantly female (60%); an age range of 19–91 years and were largely Caucasian (88%). The most common symptom prompting referral was palpitations (71%). Depending on clinical history, 82% of referred patients had cardiac monitoring. Following investigation atrial fi brillation (persistent or paroxysmal) was identifi ed in 26% of the referred patients and signifi cant paroxysmal supra-ventricular tachycardia in 5%. The remainder demonstrated atrial ectopy (17%), ventricular ectopy (13%), other arrhythmias (1%), with no arrhythmias identifi ed in 38% of the cohort. Conclusions: This audit demonstrates that a nurse-facilitated suspected arrhythmia clinic is an effective way of identifying patients with suspected heart rhythm abnormalities. From an organizational standpoint this clinic helps to reduce the burden on general cardiology clinics and helps meet NHS targets. A clear need for further published evidence is highlighted.
than warfarin for the prevention of IS/TE in AF patients. Major bleeding risk was significantly higher with rivaroxaban than dabigatran, as was all-cause mortality and GIB. Rivaroxaban was comparable to warfarin for major bleeding, with an increased risk in GIB and decreased risk of ICB. 46 AUDIT OF NEW ORAL ANTICOAGULANT MONITORING IN PRIMARY CARE; ARE PATIENTS BEING PRESCRIBED THE CORRECT DOSE?Anik Ghai*, Ian Duffus. Western Sussex Hospital NHS trust 10. 1136/heartjnl-2017-311726.45 Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly being used for the prophylaxis of stroke in patients with non-valvular atrial fibrillation (NVAF). One of their limitations is their reliance on renal clearance making them potentially more unsafe in patients with renal impairment. NICE recommend regular renal function testing in these patients as well as drug dose adjustments to be made according to their calculated CrCl. Aims 1. To identify patients with NVAF who have been prescribed NOACs and to measure the percentage of those that have had renal function tests done in the last 12 months.2. To determine if patients are being prescribed the correct anticoagulant dose as per their CrCl? 3. Are 100% of patients having their renal function and weight monitored at the correct frequency according to NICE recommendations? Methods Data was collected from two GP practices in Bognor Regis. CrCl was calculated for each patient by using the Cockgroft-Gault equation. The dose of anticoagulant was then reviewed for each patient to see if it was appropriate as per their CrCl. Results 176 patients were identified. 45% of patients were prescribed Apixiban, 41% were prescribed Rivaroxaban and 14% of patients prescribed Dabigatran.The average age of patients was 77 years old with a median age group of 78 years.84.5% of patients on NOACs had their renal function tested in the last 12 months with the remainder of patients having their renal function monitored at varying time periods greater than 12 months and less than 3 years. It was found that one patient had no record of their renal function.In order to calculate their CrCl, weight measurement is also required. However only 49% of patients had their weights checked in the last 12 months. 4% of patients had no recorded weights.Accurate CrCls could only be measured in 46% (81/176) of patients, of whom had both renal function and weights recorded in the last 12 months.Assuming stable weights, all patients prescribed apixiban and dabigatran were prescribed the correct dose as per their CrCl, however only 81% (59/73) of patients taking rivaroxban were on the correct dose. 2 patients were under anticoagulated despite normal CrCl, and 12 patients despite having impaired renal function (CrCl<50) were prescribed the higher dose. Patients with impaired renal function (CrCl<60) did not have their renal function monitored more frequently as is suggested by NICE. Summary Whilst the majority of patients have had their renal function tested in the last 12 months, a significant number are n...
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