Journal Publications
Screening and Management of Atrial Fibrillation in Primary Care (Ponamgi et al, BMJ 2021)
In this narrative review, the authors present an algorithm for the management of initial and breakthrough AF episodes. The article proposes ways to integrate care in the primary care setting with specialty and support services. Established models for integrated care, such as thrombosis or anticoagulation clinics that collaborate with primary care, are discussed. Antiarrhythmic drugs may often be started under specialty care given the need for monitoring at initiation, presence of many drug-drug interactions, and risk of serious cardiac and non-cardiac toxicities. The article also presents scenarios in which clinicians may consider specialty referral.
Transitions in Atrial Fibrillation Care: A Systematic Review (Rush et al, Heart Lung Circ 2020)
Anticoagulation interruption or discontinuation and suboptimal follow-up post-emergency department (ED) discharge are considered major transitional issues. This article synthesizes evidence examining the impact of transitional care interventions on patient, provider, and healthcare utilization outcomes. Improvements in patient outcomes, including knowledge, quality of life, and medication adherence, and increased provider anticoagulant prescriptions resulted from transitional interventions.
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Identification and Early Anticoagulation in Patients With Atrial Fibrillation in the Emergency Department (Schwab et al, Am J Emerg Med 2020)
This article describes the results of a transition-of-care protocol that was developed to improve guideline-based oral anticoagulant management in the emergency department of a medical center located in an underserved San Diego community. This article also describes treatment gaps in prescribing oral anticoagulants for patients with nonvalvular atrial fibrillation at risk for stroke in the emergency department.
An Atrial Fibrillation Transitions of Care Clinic Improves Atrial Fibrillation Quality Metrics (Abadie et al, JACC Clin Electrophysiol 2020 and SUPPL)
A novel care pathway that included an atrial fibrillation (AF)-specialized transition-of-care-clinic was developed at the University of North Carolina Hospital System to reduce admissions and improve the quality of care for AF. This study assessed whether the pathway led to improvement in and greater adherence to American College of Cardiology/American Heart Association (ACC/AHA) measures of clinical performance and quality compared with the standard of care for adults with AF.
Stroke Prevention for High-Risk Atrial Fibrillation in the Emergency Setting: The Emergency Physician Perspective (Atzema, Can J Cardiol [CJC] 2018)
This narrative review describes barriers to prescribing oral anticoagulation in the emergency department (ED) setting and proposes solutions to overcome these barriers.
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Tampa General Hospital (FL): Atrial Fibrillation Clinical Decision Aid for Emergency Medicine Providers: An Initiative to Improve Quality Healthcare Outcomes in Adults With New-Onset Atrial Fibrillation (Cardy et al, Heart Lung 2018)
This article describes institution of a clinical pathway for new-onset AF at a single emergency department (ED).
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Anticoagulation Management Services in Community Pharmacy: Feasibility of Implementing a Quality Improvement Programme Through a Practice-Based Research Network (Chartrand et al, J Clin Pharm Ther [JCPT] 2018)
This review describes the feasibility of implementing an anticoagulation management service for patients with atrial fibrillation in the community pharmacy setting and identifies potential improvements in quality of care indicators.
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St. Joseph Mercy Hospital (MI): Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation (DeMeester et al, Acad Emerg Med [AEM] 2018)
This article describes implementation of a clinical pathway to identify and treat low-risk patients with AF in the ED of a community hospital in Michigan.
Novel Care Pathway for Patients Presenting to the Emergency Department With Atrial Fibrillation (Gehi et al, Circ Cardiovasc Qual Outcomes [CIR CQO] 2018)
This article describes how the University of North Carolina at Chapel Hill ED initiated a program to reduce the rate of hospitalization for AF. Triage and management pathways were developed through a collaborative effort between health care providers from the ED and cardiology department; clinical pharmacists coordinate outpatient, next-day care for patients meeting ED discharge criteria.
Factors Influencing Oral Anticoagulation Prescription for Patients Presenting to Emergency Departments With Atrial Fibrillation and Flutter (Miller et al, Can J Cardiol [CJC] 2018)
This retrospective study sought to determine factors associated with initiation of an OAC in treatment-naïve patients with electrocardiogram (ECG)-documented AF presenting to the ED in 4 urban hospitals in Canada.
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Shared Decision-Making as the Future of Emergency Cardiology (Probst et al, Can J Cardiol [CJC] 2018)
This article explores new research and emerging shared decision-making tools in numerous emergency care scenarios, including new-onset atrial fibrillation (AF).
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Canadian Association of Emergency Physicians (CAEP): CAEP Position Statement. CAEP Acute Atrial Fibrillation/Flutter Best Practices Checklist (Stiell et al, CJEM 2018)
Recommended by the CAEP, this checklist was created to assist emergency department (ED) physicians in managing symptomatic patients who present with acute or recent-onset AF. The checklist is an adaptation of clinical practice guidelines developed by the Canadian Cardiovascular Society (CCS) for use by ED physicians. A sample pathway, along with detailed information on risk assessment, rate and rhythm control, options for short-term and long-term reduction of stroke risk in patients with AF, and follow-up are included.
Thromboprophylaxis for Patients with High-Risk Atrial Fibrillation and Flutter Discharged From the Emergency Department (Vinson et al, West J Emerg Med [WestJEM] 2018)
This prospective study examined anticoagulant prescribing among non-anticoagulated adults at high risk for ischemic stroke (Anticoagulation and Risk Factors in Atrial Fibrillation [ATRIA] score ≥7) within 30 days of receiving care for nonvalvular atrial fibrillation (NVAF) in the EDs at 7 community hospitals in California.
Benefits of Emergency Departments' Contribution to Stroke Prophylaxis in Atrial Fibrillation: The EMERG-AF Study (Emergency Department Stroke Prophylaxis and Guidelines Implementation in Atrial Fibrillation) (Coll-Vinent et al, Stroke 2017)
This prospective study analyzed the long-term (1-year) safety and benefits of prescription of an oral anticoagulant (OAC) in patients with AF in 62 EDs in Spain.
A Multi-hospital Analysis of Predictors of Oral Anticoagulation Prescriptions for Patients With Actionable Atrial Fibrillation Who Attend the Emergency Department (Scott-Herridge et al, Acute Card Care 2017)
This retrospective study sought to characterize the filling of OAC prescriptions among patients with actionable AF, defined as new or existing AF with an indication for OAC but none prescribed, and to determine the prevalence and predictors of guideline-appropriate therapy at 30 days after ED discharge.
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Reimagining Anticoagulation Clinics in the Era of Direct Oral Anticoagulants (Barnes et al, Circ Cardiovasc Qual Outcomes [CIR CQO] 2016)
This article outlines the potential role of anticoagulation clinics in the DOAC era; namely, to assist patients and clinicians in the selection of an appropriate anticoagulant, to help minimize the risk of serious bleeding complications through monitoring and periprocedural management, and to encourage adherence to prescribed therapy. Barriers to implementation of a medication safety clinic are described, along with solutions for overcoming these barriers.
Impact of an Emergency Department–Initiated Clinical Protocol for the Evaluation and Treatment of Atrial Fibrillation (Elmouchi et al, Crit Pathw Cardiol 2014)
This article describes the impact of an AF clinical pathway initiated in the ED at Spectrum Health in Michigan with early follow-up in a protocol-driven outpatient AF clinic.
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Improving Transitions of Care for Patients With Thromboembolic Disease (Owens et al, Am J Manag Care [AJMC] 2014)
This article summarizes quality gaps around transitions of care and identifies opportunities to help improve transitions of care for patients with or at risk for thromboembolic disease, including those with atrial fibrillation (AF).