Nurse-Led Protocol-Based Atrial Fibrillation Clinic Associated with High Quality Care for Patients

Ariyarathna, N.; Srinivasan, Janardhan; Hastie, C.; McCallum, C.; McManus, Margaret; Moosavi, Vahid; Yang, Q.; Nkoane-Kelaeng, B.; Olivia, Celine; Farshid, A.

doi:10.1016/j.hlc.2019.06.207

Cited by 2 publications

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“…For example, nurse-led AF clinics offer a potential approach to decentralize care for individuals with AF and improve access for residents from higher-risk neighborhoods. [39][40][41] The lessons learned from COVID-19 vaccine distribution 42 can inform the locations of AF clinics to match regional risk estimates so that care is provided in an equitable (rather than equal) manner. AF clinics can also be leveraged to enhance patients' health literacy and self-management skills 25,28,33,34,43 and the incorporation of navigation services may improve access to specialized care for eligible patients.…”

Section: Discussionmentioning

confidence: 99%

Association of Neighborhood-Level Material Deprivation With Atrial Fibrillation Care in a Single-Payer Health Care System: A Population-Based Cohort Study

et al. 2022

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Background: There are limited data on the association of material deprivation with clinical care and outcomes after atrial fibrillation (AF) diagnosis in jurisdictions with universal health care. Methods: This was a population-based cohort study of individuals ≥66 years of age with first diagnosis of AF between April 1, 2007, and March 31, 2019, in the Canadian province of Ontario, which provides public funding and prohibits private payment for medically necessary physician and hospital services. Prescription medications are subsidized for residents >65 years of age. The primary exposure was neighborhood material deprivation, a metric derived from Canadian census data to estimate inability to attain basic material needs. Neighborhoods were categorized by quintile from Q1 (least deprived) to Q5 (most deprived). Cause-specific hazards regression was used to study the association of material deprivation quintile with time to AF-related adverse events (death or hospitalization for stroke, heart failure, or bleeding), clinical services (physician visits, cardiac diagnostics), and interventions (anticoagulation, cardioversion, ablation) while adjusting for individual characteristics and regional cardiologist supply. Results: Among 347 632 individuals with AF (median age 79 years, 48.9% female), individuals in the most deprived neighborhoods (Q5) had higher prevalence of cardiovascular disease, risk factors, and noncardiovascular comorbidity relative to residents of the least deprived neighborhoods (Q1). After adjustment, Q5 residents had higher hazards of death (hazard ratio [HR], 1.16 [95% CI, 1.13–1.20]) and hospitalization for stroke (HR, 1.16 [95% CI, 1.07–1.27]), heart failure (HR, 1.14 [95% CI, 1.11–1.18]), or bleeding (HR, 1.16 [95% CI, 1.07–1.25]) relative to Q1. There were small differences across quintiles in primary care physician visits (HR, Q5 versus Q1, 0.91 [95% CI, 0.89–0.92]), echocardiography (HR, Q5 versus Q1, 0.97 [95% CI, 0.96–0.99]), and dispensation of anticoagulation (HR, Q5 versus Q1, 0.97 [95% CI, 0.95–0.98]). There were more prominent disparities for Q5 versus Q1 in cardiologist visits (HR, 0.84 [95% CI, 0.82–0.86]), cardioversion (HR, 0.80 [95% CI, 0.76–0.84]), and ablation (HR, 0.45 [95% CI, 0.30–0.67]). Conclusions: Despite universal health care and prescription medication coverage, residents of more deprived neighborhoods were less likely to visit cardiologists or receive rhythm control interventions after AF diagnosis, even though they exhibited higher cardiovascular disease burden and higher risk of adverse outcomes.

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Section: Discussionmentioning

confidence: 99%

Association of Neighborhood-Level Material Deprivation With Atrial Fibrillation Care in a Single-Payer Health Care System: A Population-Based Cohort Study

et al. 2022

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Presentation, Treatment and Long-Term Outcomes of a Multidisciplinary Acute Atrial Fibrillation Pathway: A 12-Month Follow-Up Study

Al-Busaidi

Clare

Joyce

et al. 2022

Heart, Lung and Circulation

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Nurse-Led Protocol-Based Atrial Fibrillation Clinic Associated with High Quality Care for Patients

Abstract: Background: Percutaneous left atrial appendage (LAA) closure is an alternative option to anticoagulant therapy. However, the clinical outcomes using different devices in the real world are not clear.

Cited by 2 publications

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Association of Neighborhood-Level Material Deprivation With Atrial Fibrillation Care in a Single-Payer Health Care System: A Population-Based Cohort Study

Association of Neighborhood-Level Material Deprivation With Atrial Fibrillation Care in a Single-Payer Health Care System: A Population-Based Cohort Study

Presentation, Treatment and Long-Term Outcomes of a Multidisciplinary Acute Atrial Fibrillation Pathway: A 12-Month Follow-Up Study

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