Augmenting Atrial Fibrillation Care After an Emergency Department Visit

Abstract

Background: Between 2010 and 2012, the Heart Rhythm team in a tertiary care hospital completed a retrospective study that found that atrial fibrillation (AF) care can be episodic and heavily reliant on hospital resources, particularly the emergency department (ED). Problem: Patients who attend the ED with AF are at high risk of hospital admission. Approach: A nurse practitioner (NP) was added to the Heart Rhythm team to create a program to improve AF care after an ED visit. Telephone practice was one of the many processes created. Outcomes: Findings revealed that 37 of 90 patients presented to the ED with AF prior to telephone contact and 7 of 90 patients did so post–telephone contact (P < .001). Conclusion: Telephone practice led by an NP provides an opportunity to improve assessment and management of patient with AF and offers a promising cost-effective method to reduce ED visits in the AF patient population.

Telemedicine practices in adult patients with atrial fibrillation

“…None presented randomized controlled trials. These articles were, respectively, a retrospective, descriptive, exploratory report (Hart et al, 2019); a qualitative descriptive study (Rush, Hatt, et al, 2019); and a mixed-methods study (Rush, Burton, et al, 2019). This finding confirms a lack of literature concerning AF telehealth education and treatment programs unrelated to postablation or early detection of atrial fibrillation.…”

“…Without specialized care, patients may not receive needed oral anticoagulation. One study indicated that 15% of all strokes in the general population are linked to AF (Hart et al, 2019). Additionally, inadequately managed AF leads to a fivefold increase in reported psychosocial distress and worsening quality of life (Rush, Burton, et al, 2019).…”

“…The second emergent outcome concerned the type of timely education needed by AF patients. Interventions providing education about the importance of stroke prevention, management options, and a broad overview of AF reduced ED visits for individuals by 81% (Hart et al, 2019). A qualitative study indicated that individuals want education about AF symptom management, available treatment options, activity restrictions, and explanation of the risks presented by oral anticoagulation such as potential falls and bleeding (Rush, Burton, et al, 2019).…”

“…Processes for appointments to access cardiac electrophysiology specialty care after ED visits cause delays in health care access. These delays produce gaps in AF treatment, increase readmissions, and result in higher health care costs (Hart et al, 2019). AF education programs delivered by telemedicine have the potential to decrease referral wait times and improve AF outcomes.…”

Characteristics of an allied health–led telemedicine clinic for atrial fibrillation

“…The result is fragmentation of care, leading to repeated emergency department evaluations and escalated healthcare costs. 1 Allied health professionals (AHPs) in cardiac electrophysiology have the expertise to deliver integrated AF care through telemedicine. Such a program has the potential to expand access to specialized AF care and improve outcomes.…”