Treating the right patient at the right time: an innovative approach to the management of atrial fibrillation

Abstract

The Canadian Cardiovascular Society Access to Care Working Group recently published a series of commentaries on access to cardiovascular care in Canada. These commentaries included proposed minimally acceptable wait times for patients with atrial fibrillation (AF) to be assessed by a cardiologist or an electrophysiologist. To improve access to medical care for the patient with AF, a nurse clinician-based AF clinic was established in the Calgary Health Region (Alberta) in 2005. More than 330 patients had been referred at the time of writing. The time from referral to initial nurse assessment was 38+/-31 days, to physician review and establishment of a management plan was 66+/-49 days and to in-person specialist physician assessment was 80+/-55 days. These wait times are markedly shorter than historical wait times to see an arrhythmia specialist in the Calgary Region. As experience increased, wait times continued to shorten significantly. Preliminary data suggest that early assessment and patient education may reduce emergency department visits and hospitalizations for AF. This experience suggests that a nurse clinician-based AF clinic may provide earlier access to medical care and may improve health outcomes in the long term.

Figures

Figure 1)

Flow chart of atrial fibrillation clinic referral and patient assessment and management process

Figure 2)

Distribution of wait times for assessment by the atrial fibrillation (AF) clinic nurse clinician, review of patient by the AF clinic physician (MD) or direct patient assessment by the AF clinic nurse and MD

Figure 3)

Wait times to assessment by an AF clinic (AFC) nurse between January 2006 and September 2006 compared with wait times for assessment of a patient with AF referred to an electrophysiologist in the cardiac arrhythmia clinic (CAC) at the University of Calgary, Calgary, Alberta, between January 2005 and September 2005. Apr April; Aug August; Feb February; Jan January; Jul July; Jun June; Mar March; Sep September

Figure 4)

Changes in the distribution of wait times for assessment by the atrial fibrillation (AF) clinic nurse clinician, review of patient by the AF clinic physician or direct patient assessment by the AF clinic nurse and physician. The distribution of wait times for the first 50 patients assessed in 2005 is shown in the upper panel. The distribution of wait times for assessment of all subsequent patients is shown in the lower panel