title: An Integrated Management Approach to Atrial Fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia resulting in mortality and morbidity. Gaps in oral anticoagulation and education of patients regarding AF have been identified as areas that require improvement.
  
  
  RESULTS
  A before-and-after study of 433 patients with newly diagnosed AF in the 3 emergency departments in Nova Scotia from January 1, 2011 until January 31, 2014 was performed. The "before" phase underwent the usual-care pathway for AF management; the "after" phase was enrolled in a nurse-run, physician-supervised AF clinic. The primary outcome was a composite of death, cardiovascular hospitalization, and AF-related emergency department visits. A propensity analysis was performed to account for differences in baseline characteristics.
  
  
  RESULTS
  A total of 185 patients were enrolled into the usual-care group, and 228 patients were enrolled in the AF clinic group. The mean age was 64±15 years and 44% were women. In a propensity-matched analysis, the primary outcome occurred in 44 (26.2%) patients in the usual-care group and 29 (17.3%) patients in the AF clinic group (odds ratio 0.71; 95% CI [0.59, 1]; P=0.049) at 12 months. Prescription of oral anticoagulation was increased in the CHADS2 ≥2 group (88.4% in the AF clinic versus 58.5% in the usual-care group, P<0.01).
  
  
  CONCLUSIONS
  Adoption of this integrated management approach for the burgeoning population of AF may provide an overall benefit to cardiovascular morbidity and mortality.
authors.affiliation: Department of Medicine, QEII Health Sciences Center, Halifax, Canada (L.C., M.G., A.F., I.M., J.L.S., C.G., A.A., R.P.).
authors.forename: Lindsey
authors.initials: L
authors.lastname: Carter
authors.affiliation: Department of Medicine, QEII Health Sciences Center, Halifax, Canada (L.C., M.G., A.F., I.M., J.L.S., C.G., A.A., R.P.).
authors.forename: Martin
authors.initials: M
authors.lastname: Gardner
authors.affiliation: Department of Emergency Medicine, QEII Health Sciences Center, Halifax, Canada (K.M.).
authors.forename: Kirk
authors.initials: K
authors.lastname: Magee
authors.affiliation: Department of Medicine, QEII Health Sciences Center, Halifax, Canada (L.C., M.G., A.F., I.M., J.L.S., C.G., A.A., R.P.).
authors.forename: Ann
authors.initials: A
authors.lastname: Fearon
authors.affiliation: Department of Medicine, QEII Health Sciences Center, Halifax, Canada (L.C., M.G., A.F., I.M., J.L.S., C.G., A.A., R.P.).
authors.forename: Inna
authors.initials: I
authors.lastname: Morgulis
authors.affiliation: Research Methods Unit, Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada (S.D.).
authors.forename: Steve
authors.initials: S
authors.lastname: Doucette
authors.affiliation: Department of Medicine, QEII Health Sciences Center, Halifax, Canada (L.C., M.G., A.F., I.M., J.L.S., C.G., A.A., R.P.).
authors.forename: John L
authors.initials: JL
authors.lastname: Sapp
authors.affiliation: Department of Medicine, QEII Health Sciences Center, Halifax, Canada (L.C., M.G., A.F., I.M., J.L.S., C.G., A.A., R.P.).
authors.forename: Chris
authors.initials: C
authors.lastname: Gray
authors.affiliation: Department of Medicine, QEII Health Sciences Center, Halifax, Canada (L.C., M.G., A.F., I.M., J.L.S., C.G., A.A., R.P.).
authors.forename: Amir
authors.initials: A
authors.lastname: Abdelwahab
authors.affiliation: Department of Medicine, QEII Health Sciences Center, Halifax, Canada (L.C., M.G., A.F., I.M., J.L.S., C.G., A.A., R.P.).
authors.forename: Ratika
authors.initials: R
authors.lastname: Parkash
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia; D016017:Odds Ratio; D010044:Outpatient Clinics, Hospital; D010348:Patient Care Team; D057216:Propensity Score; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: atrial fibrillation; quality and outcomes
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