A Pulse-Check on Our Health: The Atrial Fibrillation ... · A Pulse-Check on Our Health: The Atrial...
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A Pulse-Check on Our Health: The Atrial Fibrillation Identification ProjectJanice Throndson1, Céline Tritten1, Joni Kupka1, Dr. Rebecca Purc-Stephenson2 & Cherylyn Antymniuk3
1 Heart and Stroke Clinic, St. Mary’s Hospital, 2 University of Alberta, 3 Site Administrator, St. Mary’s Hospital
• Project included patients older than 18 presenting to the ED between July 2012 – December 2014, where 60 second pulse check was implemented.
• Figure 1. Summary of program algorithm for detecting A-Fib
• The St. Mary’s Hospital (SMH) Heart and Stroke Clinic (H & S Clinic) began the AtrialFibrillation (AFib) Identification Project in July 2012. The A-Fib Identification Project involvesscreening all patients presenting to the emergency department (ED) over the age of 18 forundiagnosed AFib.
• What makes this initiative unique at St. Mary’s Hospital is:
o The first acute care Emergency Department in Alberta to implement the 60second pulse check.
o Our rural hospital setting.o Patients followed throughout continuum of care from detection, investigation,
treatment, recommendations at Heart and Stroke Clinic.o The program is still currently running without dedicated funding since beginning.
Goals of the A-Fib Program:
Stroke prevention
Reduction of system costs
Continuity of Care
Screen all patients over 18 years
Manual 60 sec pulse check
Rhythm Irregular
ECG
Positive for Atrial Fib
Notify ER physician to confirm ECG interpretation
Referral to H&S
CHA2DS2VASC2, anticoag, teaching &
follow-up
Negative for Atrial Fib
Provide Patient with Irregular Heartbeat Information Sheet
SMH Heart and Stroke Clinic notified
Holter ordered, follow up H&S Clinic
Rhythm Regular
No Further action needed. Patient is
reassured.
• The AFib Program at St. Mary’s Hospital provides validity of the 60 second pulse check todetect undiagnosed AFib as well as other potentially life threatening arrhythmias.
• Approximately 3 new cases of AFib are detected each month.• Nearly 25% of all positive AFib cases identified were patients between 18 and 64 years old.• Since continuing this program into 2015, an additional 23 patients have been diagnosed with
A-Fib. Thus, 110 pts have been diagnosed with A-Fib to date (July 2012 – August 2015).• We propose that the 60 second pulse check become standard of care in EDs across Canada.
For more information, please contact Janice Throndson at:[email protected]
Background & Goals Results
Methods
A highlight of our program outcomes
at SMH
31,359 patients screened
16 urgent Holter results for Cardiology Assessment and
Devices
87 patientsnewly diagnosed with A-Fib
• All newly identified AFib patients are followed in the H & S Clinic and are seen by acardiologist/neurologist and primary physician to commence anticoagulation and A-Fibeducation.
• If Coumadin is indicated, a referral is sent to the Camrose PCN for further INR/anticoagulationteaching.
• All other urgent Holters/abnormal arrhythmias are reviewed by H & S Clinic staff and seen inclinic by a cardiologist for treatment and navigation for intervention, if necessary.
Follow-Up Care
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Patients who took Holter test
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Conclusions
Figure 4. Number and age of patients identified with an irregular pulse
Figure 3. Patients recommended and taking Holter test
Key Findings of our AFib Program:Helps ensure optimal stroke prevention
Provides continuity of care from ED to H&S clinic
Results in proactive cost reduction
Figure 2. Overview of AFib Program results from St. Mary’s Hospital for the period of July 2012 to December 2014
558 Holters ordered
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18-34 (n = 49) 35-64 (n = 151) 65+ (n = 290)
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Figure 5. Patients who follow-through with Holter test
Figure 7. Patients diagnosed with AFib
Figure 6. Reasons for not following-through with Holter test
23%
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refusednot from areatranferredunable to contactno reason givennot appropriatedeceased
Why some patients might not follow through with testing (from stakeholder interviews):• Lack of understanding – 82% believed
patients simply do not understand the nature and seriousness of condition
• Service access issues – 45% said accessing services could be difficult for patients
• Lack of family physician in area – 36% stated many patients in the community do not have a family physician