Dataset Information

Completion of guideline-recommended initial evaluation of atrial fibrillation.

ABSTRACT: BACKGROUND:Guidelines recommend evaluation of cardiac function, valvular and ischemic heart disease, and thyroid, kidney, and liver function on initial diagnosis of atrial fibrillation (AF). HYPOTHESIS:We hypothesized that initial workup of patients with newly identified AF would vary by age, sex, and burden of comorbid illness. METHODS:In a retrospective analysis of a large sample of commercially insured patients 18 to 64 years old (n = 40 245) and a nationally representative 5% cohort of Medicare beneficiaries 65 years or older (n = 204 676), we measured claims for guideline-recommended services for initial evaluation of AF among patients with a new diagnosis between 2000 and 2008. RESULTS:From 30 days before through 90 days after AF diagnosis, basic evaluation, including physician visit, electrocardiogram, and echocardiography, was completed in up to 66.6% of patients. Completion rates for all guideline-recommended evaluations were 17.4% in the commercially insured sample and 18.5% in the Medicare cohort in 2007. Evaluation rates increased over time. Blood tests assessing thyroid function were documented for approximately one-third of patients in each cohort. Increasing the observation period to 1 year before through 3 months after the AF diagnosis markedly increased completion rates, but rates of thyroid function testing remained low (50%-60%). There were minor differences in evaluation completeness by sex, race, and geographic region. CONCLUSIONS:Differences in guideline-recommended evaluation rates by demographic characteristics after a new diagnosis of AF were of minor clinical importance. Basic evaluation had satisfactory completion rates; however, rates of laboratory testing were low.

SUBMITTER: Sinner MF

PROVIDER: S-EPMC3652268 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Completion of guideline-recommended initial evaluation of atrial fibrillation.

Sinner Moritz F MF Greiner Melissa A MA Mi Xiaojuan X Hernandez Adrian F AF Jensen Paul N PN Piccini Jonathan P JP Setoguchi Soko S Walkey Allan J AJ Heckbert Susan R SR Benjamin Emelia J EJ Curtis Lesley H LH

Clinical cardiology 20120913 10

<h4>Background</h4>Guidelines recommend evaluation of cardiac function, valvular and ischemic heart disease, and thyroid, kidney, and liver function on initial diagnosis of atrial fibrillation (AF).<h4>Hypothesis</h4>We hypothesized that initial workup of patients with newly identified AF would vary by age, sex, and burden of comorbid illness.<h4>Methods</h4>In a retrospective analysis of a large sample of commercially insured patients 18 to 64 years old (n = 40 245) and a nationally representat ...[more]

PMID: 22976579

Similar Datasets

Project description:ObjectiveTo assess whether atrial fibrillation (AF) self-screening stations in general practice waiting rooms improve AF screening, diagnosis, and stroke risk management.Design, settingIntervention study (planned duration: twelve weeks) in six New South Wales general practices (two in rural locations, four in greater metropolitan Sydney), undertaken during 28 August 2020 - 5 August 2021.ParticipantsPeople aged 65 years or more who had not previously been diagnosed with AF, and had appointments for face-to-face GP consultations. People with valvular AF were excluded.InterventionAF self-screening station and software, integrated with practice electronic medical record programs, that identified and invited participation by eligible patients, and exported single-lead electrocardiograms and automated evaluations to patients' medical records.Main outcome measuresScreening rate; incidence of newly diagnosed AF during intervention and pre-intervention periods; prescribing of guideline-recommended anticoagulant medications.ResultsAcross the six participating practices, 2835 of 7849 eligible patients (36.1%) had face-to-face GP appointments during the intervention period, of whom 1127 completed AF self-screening (39.8%; range by practice: 12-74%). AF was diagnosed in 49 screened patients (4.3%), 44 of whom (90%) had CHA2 DS2 -VA scores of 2 or more (high stroke risk). The incidence of newly diagnosed AF during the pre-intervention period was 11 cases per 1000 eligible patients; during the intervention period, it was 22 per 1000 eligible patients (screen-detected: 17 per 1000 eligible patients; otherwise detected: 4.6 per 1000 eligible patients). Prescribing of oral anticoagulation therapy for people newly diagnosed with AF and high stroke risk was similar during the pre-intervention (20 of 24, 83%) and intervention periods (46 of 54, 85%).ConclusionsAF self-screening in general practice waiting rooms is a feasible approach to increasing AF screening and diagnosis rates by reducing time barriers to screening by GPs. AF self-screening could reduce the number of AF-related strokes.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12620000233921 (prospective).

Project description:IntroductionScreening for atrial fibrillation (AF) in people ≥65 years is now recommended by guidelines and expert consensus. While AF is often asymptomatic, it is the most common heart arrhythmia and is associated with increased risk of stroke. Early identification and treatment with oral anticoagulants can substantially reduce stroke risk. The general practice setting is ideal for opportunistic screening and provides a natural pathway for treatment for those identified.This study aims to investigate the feasibility of implementing screening for AF in rural general practice using novel electronic tools. It will assess whether screening will fit within an existing workflow to quickly and accurately identify AF, and will potentially inform a generalisable, scalable approach.Methods and analysisScreening with a smartphone ECG will be conducted by general practitioners and practice nurses in rural general practices in New South Wales, Australia for 3-4 months during 2018-2019. Up to 10 practices will be recruited, and we aim to screen 2000 patients aged ≥65 years. Practices will be given an electronic screening prompt and electronic decision support to guide evidence-based treatment for those with AF. De-identified data will be collected using a clinical audit tool and qualitative interviews will be conducted with selected practice staff. A process evaluation and cost-effectiveness analysis will also be undertaken. Outcomes include implementation success (proportion of eligible patients screened, fidelity to protocol), proportion of people screened identified with new AF and rates of treatment with anticoagulants and antiplatelets at baseline and completion. Results will be compared against an earlier metropolitan study and a 'control' dataset of practices.Ethics and disseminationEthics approval was received from the University of Sydney Human Research Ethics Committee on 27 February 2018 (Project no.: 2017/1017). Results will be disseminated through various forums, including peer-reviewed publication and conference presentations.Trial registration numberACTRN12618000004268; Pre-results.

Project description:BackgroundAtrial fibrillation (AF) may occur after an acute precipitant and subsequently resolve. Management guidelines for AF in these settings are unclear as the risk of recurrent AF and related morbidity is poorly understood. We examined the relations between acute precipitants of AF and long-term recurrence of AF in a clinical setting.MethodsFrom a multi-institutional longitudinal electronic medical record database, we identified patients with newly diagnosed AF between 2000 and 2014. We developed algorithms to identify acute AF precipitants (surgery, sepsis, pneumonia, pneumothorax, respiratory failure, myocardial infarction, thyrotoxicosis, alcohol, pericarditis, pulmonary embolism, and myocarditis). We assessed risks of AF recurrence in individuals with and without a precipitant and the relations between AF recurrence and heart failure, stroke, and mortality.ResultsAmong 10 723 patients with newly diagnosed AF (67.9±9.9 years, 41% women), 19% had an acute AF precipitant, the most common of which were cardiac surgery (22%), pneumonia (20%), and noncardiothoracic surgery (15%). The cumulative incidence of AF recurrence at 5 years was 41% among individuals with a precipitant compared with 52% in those without a precipitant (adjusted hazard ratio [HR], 0.75 [95% CI, 0.69-0.81]; P<0.001). The lowest risk of recurrence among those with precipitants occurred with postoperative AF (5-year incidence 32% in cardiac surgery and 39% in noncardiothoracic surgery). Regardless of the presence of an initial precipitant, recurrent AF was associated with increased adjusted risks of heart failure (hazard ratio, 2.74 [95% CI, 2.39-3.15]; P<0.001), stroke (hazard ratio, 1.57 [95% CI, 1.30-1.90]; P<0.001), and mortality (hazard ratio, 2.96 [95% CI, 2.70-3.24]; P<0.001).ConclusionsAF after an acute precipitant frequently recurs, although the risk of recurrence is lower than among individuals without an acute precipitant. Recurrence is associated with substantial long-term morbidity and mortality. Future studies should address surveillance and management after newly diagnosed AF in the setting of an acute precipitant.

Project description:IntroductionPulsed field ablation (PFA) was recently introduced for the treatment of symptomatic atrial fibrillation (AF) with the claim of selectively ablating the myocardium while sparing surrounding tissues. We present our initial experience with a PFA catheter for pulmonary vein isolation (PVI) and describe procedural findings and peri-procedural safety of the first 100 patients.Materials and methodsWe investigated 100 patients treated for symptomatic AF using the FARAWAVE PFA catheter (Farapulse, Menlo Park, CA, USA) between July 2021 and March 2022. Procedure workflow and electrophysiological findings at the time of ablation, peri-procedural complications, and operator learning curves are described.ResultsThe mean age of patients was 62.9 ± 9.4 years, 62% were male subjects and 80% had paroxysmal AF. The median CHA2DS2-VASc score was 1.5 (IQR: 1.0-2.0) and the mean left atrial volume index was 35.7 ± 9.6 ml/m2. In 88 (88%) patients, PVI alone was performed and in 12 (12%) patients additional ablation of the posterior wall was performed. 3D-electroanatomic mapping was performed in 18 (18%) patients. Procedures without mapping lasted for 52.3 ± 16.6 min. The mean number of applications per pulmonary vein (PV) was 8.1 ± 0.6. In all patients (100%), all PVs were confirmed to be isolated. The learning curves of the two operators who performed > 20 procedures showed a negligible variation of performance over time and practice did not significantly predict procedure time [Operator 1 (senior): R 2 = 0.034, p = 0.35; Operator 2 (junior): R 2 = 0.004, p = 0.73]. There was no difference between the procedure times between senior and junior operators (Operator 1: 46.9 ± 9.7 min vs. Operator 2: 45.9 ± 9.9 min; p = 0.73). The only complications observed were two cases of bleeding at the site of percutaneous access.ConclusionOur initial experience shows that use of the PFA catheter for pulmonary vein isolation (PVI) is safe, fast, and easy to learn.

Dataset Information

Completion of guideline-recommended initial evaluation of atrial fibrillation.

Publications

Completion of guideline-recommended initial evaluation of atrial fibrillation.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets