Atrial Fibrillation Clinics in Canada: A Nationwide Project Report |
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Authors: | Jennifer Cruz Zana Mariano Paul Dorian |
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Institution: | 1. Cardiac Arrhythmia Service, St Michael’s Hospital, Toronto, Ontario, Canada;2. University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada;3. Keenan Research Centre in the Li Ka Shing Institute of St Michael’s Hospital, Toronto, Ontario, Canada;4. University of Toronto, Faculty of Medicine, Institute of Medical Science, Toronto, Ontario, Canada |
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Abstract: | The increased prevalence of atrial fibrillation (AF) has led to specialized AF clinics (AFCs) to facilitate management of AF patients. In this article we report on outpatient AFCs in Canada, which is essential to health policies required to standardize the performance of existing AFCs and help design new AFCs. We surveyed 14 clinics in 5 provinces; 100% provided responses to a detailed questionnaire on clinic processes and care practices. Fourteen care maps were analyzed, and 5 models of care were identified; 4 were specific to AFCs. An online survey with 49 questions included items on: (1) process before visit; (2) process at visit; (3) patient education provided; (4) outreach; and (5) specific clinic information. Clinicians’ advice to patients on self-care items such as: (1) amount of alcohol and (2) caffeine intake; (3) exercise activity; (4) stressful events; (5) “when to go to the emergency department”; and (6) lifestyle changes, were evaluated to assess consistency in practice. There were moderate variances in clinicians’ advice to patients in 5 of 6 self-care items. The 1 item that had 100% consistent practice recommendation was when to go to the emergency department. A guideline-based clinical assessment checklist (CAC) was piloted to obtain feedback on its usability in real-world practice; revisions finalized the “simplified CAC” for AF care encompassing 35 data points with rationale. There was 100% positive feedback on its ability to provide baseline elements in AF care. When validated, a “simplified CAC” can facilitate a standardized clinical assessment tool in clinical practice. |
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Keywords: | Corresponding author: Jennifer Cruz St Michael’s Hospital Cardiac Arrhythmia Service 30 Bond St Room 7-081 Donnelly Wing Toronto Ontario M5B 1W8 Canada Tel : +1-416-864-6060 ×3843 fax: +1-416-864-5348 |
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