Transforming Atrial Fibrillation Care Delivery
By Sherry J. Saxonhouse, MD, FACC, FHRS
Director of Atrial Fibrillation Center of Excellence
Associate Professor of Medicine
Atrium Health Sanger Heart & Vascular Institute
Atrial fibrillation (AF) is the most common arrhythmia and has been identified as a global epidemic with rising incidence and prevalence worldwide. AF care is complex, requiring both primary and secondary prevention in addition to treatment of AF and management of modifiable risk factors.
Our team at Atrium Health Sanger Heart & Vascular Institute recognized this need and developed a multi-disciplinary approach to offering expert AF care. In accordance with the Heart Rhythm Society’s recommendation from their May 2020 white paper, Sanger developed an AF Center of Excellence (COE). The AF COE, which launched in July 2021, leverages advanced technologies and the latest in AF treatment to provide a holistic approach to patient-centered care.
AF Clinical Pathways
Standardizing care improves patient experience and elevates the quality of care. The Sanger team developed outpatient, inpatient, CT surgery and ED pathways to assist in guideline-directed treatment for AF patients. The outpatient pathway uses a standard symptom score to escalate care and indicate appropriate referral to electrophysiology, by assessing AF symptoms and increased AF burden. The inpatient pathway helps to decrease hospital length of stay and assures that patients are receiving the same high-quality care across all Atrium Health facilities with all providers.
Sanger’s ED AF care pathway provides a standardized approach to acute AF care with the goal of discharging patients with rate control and anticoagulation and a quick follow-up in with an electrophysiologist. Additionally, our team created a peri-cardiac surgery AF pathway for management of patients with known AF and medication management post-operatively, prevention of post-operative AF (POAF) in high-risk patients, and management of POAF in all patients who develop it after.
Coordinated and Patient-Centered Risk Factor Modification
Sanger’s AF COE has established screening tools for all AF patients seen in clinic. Risk factor modification includes management of diabetes, smoking cessation, and treatment of obstructive sleep apnea. Once patients have been identified as having a modifiable risk factor based on their screen, they are provided educational materials and referred to the appropriate discipline for further management.
Studies have shown that a coordinated multidisciplinary approach for AF patients has been associated with improved outcomes with 49% reduction in all-cause mortality, 42% reduction in cardiovascular hospitalizations, 50%-82% reduction in ED visits and thus more cost-effective care.
Goal: Redefine AF Care Nationwide
Throughout the development of the AF COE, Sanger’s electrophysiology team has remained focused on high-quality outcomes, which includes 83% of paroxysmal AF patients without recurrent AF up to one year.
Additionally, our Sanger team is involved in AF-related research including a number of multi-centered clinical trials – such as the ARTESiA trial (studying anticoagulation efficacy in patients with subclinical AF) - as well as several investigator-initiated clinical studies including Cardiac Rehab To Go, which leverages virtual cardiac rehabilitation for AF, and the SEA-OP study, which evaluates the efficacy of direct oral anticoagulants in morbidly obese patients.
To learn more about the Sanger’s Atrial Fibrillation Center of Excellence or refer a patient, contact 704-373-0212.