new atrial fibrillation flutter pathway and grasp tool l.
Download
Skip this Video
Download Presentation
New Atrial Fibrillation/Flutter Pathway and GRASP Tool

Loading in 2 Seconds...

play fullscreen
1 / 13

New Atrial Fibrillation/Flutter Pathway and GRASP Tool - PowerPoint PPT Presentation


  • 137 Views
  • Uploaded on

New Atrial Fibrillation/Flutter Pathway and GRASP Tool. Kay Elliott British Heart Foundation Arrhythmia Nurse Specialist Dorset County Hospital NHS Foundation Trust. To Discuss: Primary/Secondary Care Pathway for new onset atrial fibrillation/Flutter

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'New Atrial Fibrillation/Flutter Pathway and GRASP Tool' - ima


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
new atrial fibrillation flutter pathway and grasp tool

New Atrial Fibrillation/Flutter Pathway and GRASP Tool

Kay Elliott

British Heart Foundation Arrhythmia Nurse Specialist

Dorset County Hospital NHS Foundation Trust

slide2
To Discuss:

Primary/Secondary Care Pathway for new onset atrial fibrillation/Flutter

GRASP* Tool – Identifying and risk stratifying chronic AF/Flutter in primary care

*Guidance on Risk Assessment for Stroke Prevention in Atrial Fibrillation in Patients in Primary Care

Aim
slide3

New Onset Atrial Fibrillation or Flutter

Is the patient acutely unwell?

No

Yes

Primary Care

START WARFARIN AND RATE CONTROL (see box A)

Issue patient education leaflet:

‘Atrial Fibrillation and Warfarin’. Attached, also available: www.patient.co.uk/showdoc/23068883

Admit to Hospital

NEED FURTHER ADVICE?

CONTACT:

BHF ARRHTYHMIA NURSE: 01305 254920

  • Box A: Rate control
  • First Line:
  • 1.Beta-blocker (e.g. Bisoprolol) or a rate limiting calcium antagonist (e.g. Diltiazem), if beta-blocker contraindicated
  • 2.Digoxin – additional to optimise rate control, where required. As monotherapy only in predominantly sedentary patients.
  • NICE (2006)

Persistent

Fax referral to Rapid Access Atrial Fibrillation/Flutter

Clinic.

(Form attached. Also available on Dorset County Hospital intranet or by contacting BHF Arrhythmia Nurse)

Paroxysmal

Refer to cardiology team in the usual way.

Rapid Access Atrial Fibrillation/Flutter Clinic

Cardiologist

slide4

Rapid Access

  • Atrial Fibrillation/Flutter Clinic
  • ONE STOP APPOINTMENT
  • (WITHIN 4 WEEKS OF REFERRAL)
  • ECHO AND ECG
  • BHF ARRHYTHMIA NURSE CLINIC:
    • qReview history, symptoms, test and examination results
    • qPatient education
    • qAgree treatment plan: DC Cardioversion or Rate Control
    • qArrange ongoing follow-up, where required

Cardiologist input into RAAF clinic. Also patients referred for DC Cardioversion from cardiology clinic or in-patient stay.

Cardiologist

BHF Arrhythmia Nurse Specialist:

Arrange DC Cardioversion

Primary Care

Manage long-term warfarin and rate-control

slide5

Prepare for DC Cardioversion:

Weekly INR (Target 2.5-3.0), must have INR >2.0 for four full weeks prior to DC Cardioversion (see next page)

  • DC Cardioversion – BHF ARRHYTHMIA NURSE/DAY SURGERY UNIT
  • Procedure
  • Review of medications and treatment pre-discharge

(Cardiology Specialist Registrar and BHF Arrhythmia Nurse)

  • Review with BHF Arrhythmia Nurse at 4 weeks, ongoing treatment plan
  • N.B. Maintaining a therapeutic INR during the four weeks post successful DC Cardioversion is important in terms of stroke risk reduction.
slide6

4 Weeks post procedure Follow-Up (NICE, 2006)

BHF Arrhythmia Nurse

Is the Patient in Sinus Rhythm?

Yes/No

YES

NO

Cardiology Review

Patient remains symptomatic despite adequate rhythm or rate control.

Other cardiac complications are revealed.

Depending on clinical indications

and patient preference either:

Re-attempt DC Cardioversion with amiodarone cover

Refer for ablation therapy

Rate control/Warfarin (primary Care)

Refer to Electrophysiology

centre for ablation therapy, if appropriate

6 months post procedure Follow-Up (NICE, 2006)

BHF Arrhythmia Nurse

Is the Patient in Sinus Rhythm?

slide7

6 months post procedure Follow-Up (NICE, 2006)

BHF Arrhythmia Nurse

Is the Patient in Sinus Rhythm?

Yes

No

Depending on clinical indications and patient preference either:

Re-attempt DC Cardioversion with amiodarone cover

Referral for ablation therapy

Rate control/Warfarin (primary Care)

Discharged to primary care and advised to seek medical attention if symptoms recur

guidance on risk assessment for stroke prevention in atrial fibrillation grasp af
Prevalence of AF in primary care is 1.2% (England)

12,500 strokes per year are thought to be directly attributable to AF

Estimated annual cost of maintaining one patient on warfarin: £383

Estimated cost per stroke due to AF is £11,900 in the first year post stroke occurrence

Guidance on Risk Assessment for Stroke Prevention in Atrial Fibrillation (GRASP – AF)
guidance on risk assessment for stroke prevention in atrial fibrillation grasp af9
NICE estimate that 46% of patients that

should be on warfarin are not receiving it

Warfarin reduces risk of stroke by 64% in atrial fibrillation

Aspirin reduces the risk of stroke by 22% in atrial fibrillation

Guidance on Risk Assessment for Stroke Prevention in Atrial Fibrillation (GRASP – AF)
guidance on risk assessment for stroke prevention in atrial fibrillation grasp af10
The GRASP-AF Tool facilitates audit to identify high risk AF patients not on warfarin

It is a MIQUEST IT tool that can be freely downloaded from www.improvement.nhs.uk

Guidance on Risk Assessment for Stroke Prevention in Atrial Fibrillation (GRASP – AF)
guidance on risk assessment for stroke prevention in atrial fibrillation grasp af11
It can be used to identify patients in atrial fibrillation with a CHADS2 score of >1

The final report can exclude those with recorded contraindications to warfarin

Guidance on Risk Assessment for Stroke Prevention in Atrial Fibrillation (GRASP – AF)
summary
Identify new atrial fibrillation/flutter – (include

routine pulse checks at all appropriate consultations)

Refer to RAAF clinic (persistent), consultant (paroxysmal) or admit if acutely unwell

Rate Control and warfarin/aspirin in primary care

Patients will be reviewed with echocardiogram and

specialist clinic/consultant input

GRASP-AF Tool – opportunity to ensure practice

population on evidence based stroke prophylaxis

in atrial fibrillation – Potential to reduce morbidity/mortality and health costs

Summary
ad