Project ObjectiveTo enhance the system of care for atrial fibrillation that not only reduces system costs, but improves the experiences of both patients and care providers
Transitioning Emergency AFib Management:The TEAM Study
• Run by• Part of the overall • Principle Investigators:– Dr. Nazanin Meshkat, Emergency, UHN– Dr. Sacha Bhatia, Cardiology, WCH and UHN– Dr. Paul Dorian, Cardiology, SMH
• Collaboration among:
Background• Atrial fibrillation (AFIB) is the most common cardiac arrhythmia
and the incidence is growing as the population ages• AFIB patients are at significantly increased risk of stroke and
heart failure and a decreased quality of life• AFIB is responsible for an increasing number of emergency
department (ED) visits and hospitalizations• The fragmentation of care of this chronic condition is a driver
for avoidable health utilization and costs
We hypothesized that a transition of care intervention for ED patients with primary AF would reduce avoidable hospitalizations
TEAM: Intervention• INTERVENTION - In the ED:
– Acute AF order set and pathway– Patient education package and early referral appointment at discharge
• INTERVENTION - After the ED Visit:– NP-and-Pharmacist-led interdisciplinary program with Internist support
for early post-discharge patient standardized review and treatment (The Atrial Fibrillation Quality Care Program – AFQCP)
– STANDARDIZED guideline-based assessment– Principle of coordination and reintegration back to primary care
provider (PCP) with shared AF one-page Care Plan– Tailored education for patients and patient-friendly Care Plan with
clear advice for acute episode self-management– 1-855 clinician-staffed hotline for patient and PCP support– Facilitated Facilitated access to Cardiology and Electrophysiology
referral if needed.• Ease of access to diagnostic testing
Results: Patient Characteristics
• Total Eligible patients at index ED visit n=832– Total admitted=546– Total discharged=200
• Total AFQCP patients n= 155 (78%)• Median age 65 years old• 58% were male, 95% had a GP.• 40% had a history of AF, 44% HTN, 9% CAD• 15% on OACs, 28% on anti-platelet agents• 45% CHADS2=0
RESULTS
• Model improves Quality-of-Life*–Mean score at first AFQCP visit: 60.4 ±23.5–Mean score at 3 months: 84.8 ± 15.4• Clinically significant improvement in scores
– Improvement was seen in all subscales:• Symptoms• Activities of daily living • Treatment concern• Treatment satisfaction
*assessed using validated AFEQT tool
RESULTS
• 1-855 Hotline helps avoid ED visits– 56 calls to the hotline• 23 patients• 7 healthcare providers
– 11 ED visits avoided• In the opinion of both the patient and the clinician• 1 ED visit was recommended by the clinician
• Hotline for acute AF advice is feasible• **the call answerers need to be familiar with
the patients or have access to care plans
RESULTS
• The service is valued by patients, primary care providers and ED physicians
• SHARED CARE PLAN– Level of detail was ‘about right’– 64% described the care plan as having a positive or strongly
positive impact on their ability to provide care
• Stroke Prevention Adherence– 85% are on guideline recommended treatment– 4% with clinically valid reason not to take– 9% patients refuse
– Half are related to refusal to stop ASA when not indicated
TEAM: Challenges
• Health Information Access• Referrals from ED– ~38% of eligible patients
• Current remuneration strategies– Providing tailored education, care coordination
and acute access for patients takes time consuming
• Patients co-morbidity and complexity.
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