49 Rapid Access AF Clinic – A New Service Towards Better Outcome

Abstract

action had been taken to identify the episodes and notify the general practitioner (GP). Method A retrospective analysis of pacing clinic notes was made for 100 consecutive patients attending pacemaker interrogation.12 NEW cases of AF were diagnosed from the utilisation of pacemaker technology.1 (8%) of the 12 was already anticoagulated and documented.2 (17%) patients -no clear documentation of action taken e.g. GP informed.9 (75%) patients -clear documentation that GP had been informed and action had been taken.17 patients had episodes of MS greater than 30 s. 10 (59%) had intracardiac electrogram monitoring (EGM) activated and returned to clinic in two months time.1 (6%) patient had an older device with no EGM monitoring available and was fitted with a holter monitor.6 (35%) patients had no clear plan documented. A repeat retrospective analysis of 100 patients was made 6 months later and the results showed:19 NEW cases of AF were diagnosed. 3 (16%) of the 19 was already anticoagulated and documented.16 (84%) patients -clear documentation that GP had been informed and action had been taken.All patients were appropriately managed. 16 patients had episodes of MS greater than 30 s. 13 (81%) had EGM activated and returned to clinic in two months time.1 (6%) patient had an older device with no EGM monitoring available and was already anticoagulated.2 (13%) patients were nearing battery replacement and EGM storage was not activated to conserve battery life. Conclusion AF is highly prevalent in our pacemaker population. Utility of pacemaker technology by cardiac physiologists improved early detection and treatment of AF in 83% patients. This improved patient outcomes and reduced stroke risk significantly.Future improvements included a clear, auditable pathway for physiologists when AF is suspected/identified to ensure this is consistently communicated to patients and their doctors. This is reflected from the repeat retrospective study which has shown raising awareness can have an impact. Introduction Atrial fibrillation (AF) is one of the top ten reasons for hospital admissions. Failure to recognise this arrhythmia and risk stratify patients early on diagnosis can have detrimental consequences including high risk of thromboembolic events, stroke, heart failure and death. An audit conducted in our hospital (2011)(2012) revealed that patients with AF stay an average 5.6 days in hospital. It has been estimated that billions of pounds are spent each year from health and social care budgets due to AF and AF related strokes. Cardiac Rhythm Management1 To address this, a new service "Rapid access AF clinic (RAAFC)" was developed in our hospital in June 2012. This retrospective study explores the role of RAAFC on clinical outcomes since its introduction. Methods 210 patients were seen in our clinic between 01/06/ 2012 and 30/10/2015. 56 patients were excluded from the analysis --41 due to lack of access to records, 1 found to be in CHB and 14 in sinus rhythm. 154 patients were included in the final analysis. Patients were div...