Is Appropriate Management of Atrial Fibrillation in Primary Care a Utopia?

Lygidakis, Charilaos; Argyriadou, Stella; Lygera, Anastasia

doi:10.1177/2150131910361360

Cited by 5 publications

(5 citation statements)

References 19 publications

(26 reference statements)

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“…Limited provider knowledge and resources have been identified as contributors to poorer AF management in rural communities. 6 Other studies have found that patients admitted to rural hospitals for AF had a 17% greater risk of death compared to urban centers, and elderly patients in rural areas are 12% less likely to receive antithrombotic therapy despite having significantly fewer relative contraindications. 7,9 To our knowledge, no specific intervention has demonstrated the potential to bring AF care to under-resourced communities by elevating the level of care using embedded primary care providers.…”

Section: Discussionmentioning

confidence: 97%

“…1,4,5 Moreover, rural and under-resourced regions are disproportionately affected by sub-optimal care due to resource limitations and inadequate access to community providers with specialized training in AF, resulting in greater non-adherence to clinical guidelines, underutilization of stroke prophylaxis, and higher rates of in-hospital mortality compared to urban communities. [6][7][8][9][10] Primary care providers are often the sole providers serving these vulnerable patient populations and may have difficulty gaining confidence in AF care as management recommendations become increasingly complex. Disparities of access to specialty AF care may be more adequately addressed through engaging with primary care providers who can become local AF care partners.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development and Feasibility of a Primary Care Provider Training Intervention to Improve Atrial Fibrillation Management

Daw

Armbruster

Deyo

et al. 2023

Preprint

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Background: Disparities in atrial fibrillation (AF) care are partially attributed to inadequate access to providers with specialized training in AF. Primary care providers (PCPs) are often the sole providers of AF care in under-resourced regions. Objective: To create a virtual education intervention for PCPs and evaluate its impact on use of stroke risk reduction strategies in AF patients. Methods: A multi-disciplinary team mentored PCPs on AF management over 6 months using a virtual case-based training format. Surveys of participant knowledge and confidence in AF care were compared pre- and post-intervention. Hierarchical logistic regression modeling was used to evaluate change in stroke risk reduction therapies among patients seen by participants before or after training. Results: Of 41 participants trained, 49% worked in family medicine, 41% internal medicine, and 10% general cardiology. Participants attended a mean of 14 one-hour sessions. Overall, appropriate use of oral anticoagulation (OAC) therapy (CHA2DS2-VASc score >/=1 men, >/=2 women) increased from 37% to 46% (p<.001) comparing patients seen pre- (n=1739) to post- (n=610) intervention. Factors independently associated with appropriate OAC use included participant training (OR 1.4, p=.002) and participant competence in AF management (by survey). Factors associated with decreased OAC use included patient age (OR 0.8 per 10 years, p=.008), nonwhite race (OR 0.7, p=.028). Provider knowledge and confidence in AF care both improved (p<.001). Conclusions: A virtual case-based PCP training intervention improved use of stroke risk reduction therapy in outpatients with AF. This widely scalable intervention could improve AF care in under-resourced communities.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development and Feasibility of a Primary Care Provider Training Intervention to Improve Atrial Fibrillation Management

Daw

Armbruster

Deyo

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Research suggests geographic variation in AF care with some evidence showing inequitable care for those in rural communities [5]. Evidence shows that rural older adults with AF receive primary care that does not consistently meet clinical guidelines [6] and have overall higher in-hospital mortality rates compared to their hospitalized urban counterparts [7]. Although not mandated, many rural patients may never see a cardiologist or have an echocardiogram [8].…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation care in rural communities: a mixed methods study of physician and patient perspectives

Rush

Burton

Merwe³

et al. 2019

BMC Fam Pract

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BackgroundAtrial fibrillation (AF) is a serious heart arrhythmia associated with devastating outcomes such as stroke. Inequitable rural AF care may put patients at risk. Virtually delivered specialty AF care offers a viable option, but stakeholder perceptions of this option within the context of rural AF care is unknown. The study purpose was to obtain patient and primary care physician perspectives of rural AF care and virtually delivered AF care as a potential option.MethodsUsing a mixed methods design, AF patients (n = 101) and physicians (n = 15) from three rural communities participated in focus groups and/or surveys. Focus group data were thematically analyzed, survey data were descriptively analyzed, and data were triangulated.ResultsFindings captured patients’ and physicians’ perceptions of prioritized, needs, concerns and problems in AF management, available/unavailable services, and their ideas about virtual AF care. Patients and physicians identified eclectic problems in managing AF. Overall, patients felt ill informed about managing their AF and their most salient problems related to fatigue, exercise intolerance, weight maintenance, sleep apnea, and worry about stroke and bleeding. Physicians found treating patients with co-morbidities and cognitive decline problematic and balancing risks related to anticoagulation challenging. Patients and physicians identified education as a pressing need, which physicians lacked time and resources to meet. Despite available rural services, access to primary and cardiology care was a recurring challenge, and emergency department (ED) use highly contentious but often the only option for accessing care. Physicians’ managed AF care and varied in the referrals they made, often reserving them for complex situations to avoid patient travel. Patients and providers supported a broad approach to virtual AF care, tailored to an inclusive rural patient demographic.ConclusionsThe study offered valuable physician and patient perspectives on AF care in rural communities including diverse management challenges, gaps in access to primary and specialty services that made ED an often used but contentious option. Findings point to the potential value of virtual care designed to reach patients with AF across the spectrum and geared to local contexts that preserve the vital role of primary care physicians in AF care in their communities.

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“…It creates challenges for providers working in rural communities who are already faced with workload issues, blurring of personal and professional boundaries, isolation, and lack of professional development opportunities (Buykx et al, 2010). Research demonstrates rural older adults with AF experience breaks in continuity of care when hospitalized outside their communities (Biem et al, 2003), receive primary care failing to meet guidelines (Lygidakis et al, 2010), and may never have seen a cardiologist or had an echocardiogram ( Jordan et al, 2011). Compared to their urban counterparts, rural older adults with AF receive less antithrombotic therapy (Kakkar et al, 2013) despite having similar risks for stroke and bleeding (Tsadok et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Risks and older adults with atrial fibrillation in rural communities: an integration lens

Rush

Oelke

Reid

et al. 2016

Journal of Integrated Care

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Purpose – Older adults with atrial fibrillation (AF) have put growing demands on a poorly integrated healthcare system. This is of particular concern in rural communities with rapid population aging and few healthcare resources elevating risk of stroke and mortality. The purpose of this paper is to explore healthcare delivery risks for rural older adults with AF. Design/methodology/approach – This qualitative study collected data from AF patients, healthcare providers and decision makers. Ten patients participated in six-month care journeys involving interviews, logs, photos, and chart reviews. In total, 13 different patients and ten healthcare providers participated in focus groups and two decision makers participated in interviews. Findings – Three key health service risks emerged: lack of patient-focussed access and self-management; unplanned care coordination and follow-up across the continuum of care; and ineffective teamwork with variable perspectives among patients, providers, and decision makers. Originality/value – This study extends the understanding of risks to the health system level. Results provide important information for further research aimed at interventions to improve health service delivery and policy change to mitigate risks for this population.

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Is Appropriate Management of Atrial Fibrillation in Primary Care a Utopia?

Cited by 5 publications

References 19 publications

Development and Feasibility of a Primary Care Provider Training Intervention to Improve Atrial Fibrillation Management

Development and Feasibility of a Primary Care Provider Training Intervention to Improve Atrial Fibrillation Management

Atrial fibrillation care in rural communities: a mixed methods study of physician and patient perspectives

Risks and older adults with atrial fibrillation in rural communities: an integration lens

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