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84 Impact of the introduction of an integrated multi-professional pathway for atrial fibrillation on long-term outcomes
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  1. Saadia Aslam,
  2. Clare Vickers,
  3. Wendy Veevers,
  4. Layla Farrar,
  5. Elizabeth Hartley,
  6. Karthik Viswanathan
  1. Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK

Abstract

Background An integrated structured approach to atrial fibrillation (AF) management is recommended by ESC.1 However, limited data is available on its ‘real-world’ impact on anticoagulation uptake and subsequent AF-related hospitalisation and stroke rates.

Purpose To evaluate the long-term impact of the introduction of a community-wide integrated AF service based in a secondary care hospital.

Methods In September 2017 we implemented a new integrated pathway for patients with newly diagnosed ‘symptomatic’ atrial arrhythmias across two regions (population 450,000) in England in collaboration with primary care. All patients were seen in a one-stop multi-professional clinic (Arrhythmia nurse and Electrophysiologist with ECG and echocardiogram) within 2 weeks. They underwent standardised screening for modifiable risk factors, counselling regarding diagnosis/ anticoagulation and received an individualised AF management plan as well as access to a nurse-led telephone helpline. We followed up the first 126 consecutive patients for a period of 12 months.

Results Baseline characteristics are shown in table 1, showing a high incidence of modifiable risk factors (previously un-identified in the majority). After review in clinic, 30-day AF-related readmission rates to hospital were low (1.6%, n=2) as compared to historical local data (5.8%). This was sustained at 3 months (4.7%, n=6) and at 12 months (7.9%, n=10). 99% of 83 of eligible patients (CHA2DS2-VASc score of >2 with no major contra-indications) received oral anticoagulation. Over 12 months follow-up, rates of TIA/stroke was low (n=3, 2.4%). All-cause mortality was also low (n=1, 0.8%). NHS England region-wide data showed a marked reduction in percentage of total stroke admissions with history of AF not taking anticoagulation at stroke presentation in 2018/19 as compared to 2017/18 across our two regions; this was lower than the national average and the lowest within West Yorkshire (figure 1).2

Abstract 84 Table 1

Conclusions An integrated service for AF management implemented community-wide was associated with high uptake of oral anticoagulation among eligible patients and low rates of AF-related hospitalisations and all-cause mortality. Across the community, among stroke admissions with AF at presentation, a lower percentage of patients without anticoagulation was observed in comparison with previous years and neighbouring regions.

Conflict of Interest none

  • atrial fibrillation
  • stroke
  • long term outcomes

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