Author + information
- Received May 6, 2019
- Revision received September 2, 2019
- Accepted September 5, 2019
- Published online October 30, 2019.
- Bryan Q. Abadie, MDa,
- Benjamin Hansen, PharmDb,
- Jennifer Walker, ANP-BCa,
- Zachariah Deyo, PharmDa,c,
- Kevin Biese, MDd,
- Tiffany Armbruster, AGNP-Ca,
- Samuel F. Sears, PhDe,
- Heather Tuttle, BSN-RNd,
- Murrium I. Sadaf, MDf and
- Anil K. Gehi, MDa,∗ ()
- aDivision of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- bDepartment of Pharmacy, Wake Forest Baptist Health, Winston-Salem, North Carolina
- cDivision of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
- dDepartment of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- eDepartments of Psychology, Cardiovascular Sciences, and Public Health, East Carolina University, Greenville, North Carolina
- fDivision of Internal Medicine, Yale School of Medicine (Waterbury Campus), Waterbury, Connecticut
- ↵∗Address for correspondence:
Dr. Anil K Gehi, Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, 160 Dental Circle, CB 7075, Chapel Hill, North Carolina 27599.
Objectives This study sought to assess whether an atrial fibrillation (AF)–specific clinic is associated with improved adherence to American College of Cardiology (ACC)/American Heart Association (AHA) clinical performance and quality measures for adults with AF or atrial flutter.
Background There are significant gaps in care of patients with AF, including underprescription of anticoagulation and treatment of AF risk factors. An AF specialized clinic was developed to reduce admissions for AF but may also be associated with improved quality of care.
Methods This retrospective study compared adherence to ACC/AHA measures for patients who presented to the emergency department for AF between those discharged to a typical outpatient appointment and those discharged to a specialized AF transitions clinic run by an advanced practice provider and supervised by a cardiologist. Screening and treatment for common AF risk factors was also assessed.
Results The study enrolled 78 patients into the control group and 160 patients into the intervention group. Patients referred to the specialized clinic were more likely to have stroke risk assessed and documented (99% vs. 26%; p < 0.01); be prescribed appropriate anticoagulation (97% vs. 88%; p = 0.03); and be screened for comorbidities such as tobacco use (100% vs. 14%; p < 0.01), alcohol use (92% vs. 60%; p < 0.01), and obstructive sleep apnea (90% vs. 13%; p < 0.01) and less likely to be prescribed an inappropriate combination of anticoagulant and antiplatelet medications (1% vs. 9%; p < 0.01).
Conclusions An AF specialized clinic was associated with improved adherence to ACC/AHA clinical performance and quality measures for adult patients with AF.
Funding for this project was provided by the 2015 Innovation Pilot Award (Chapel Hill, North Carolina), University of North Carolina Center for Health Innovation (Chapel Hill, North Carolina), and the Bristol-Myers Squibb Foundation (New York, New York). Ms. Walker and Dr. Deyo has received grant support from the Bristol-Myers Squibb Foundation. Dr. Sears has received grant support and honoraria and modest consulting fees from Zoll, Abbott, and Medtronic. Dr. Gehi has received research grant support from the Bristol-Myers Squibb Foundation; received speaker honoraria from Biotronik, Zoll, and Abbott; and served as a consultant/speaker for Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 6, 2019.
- Revision received September 2, 2019.
- Accepted September 5, 2019.
- 2019 American College of Cardiology Foundation
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