1 / 26

Poole AF/ A Flutter Clinic 2011

Poole AF/ A Flutter Clinic 2011. Diane Bruce Consultant Cardiologist PHNHSFT. Background. DLB –appointed 1994 “jobbing cardiologist” GP lecture “Lets be active about AF” 2010 Job planning changes-etc NICE guidance re AF clinic Main problem-setting up new service

lizina
Download Presentation

Poole AF/ A Flutter Clinic 2011

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Poole AF/ A Flutter Clinic2011 Diane Bruce Consultant Cardiologist PHNHSFT

  2. Background • DLB –appointed 1994 “jobbing cardiologist” • GP lecture “Lets be active about AF” • 2010 Job planning changes-etc • NICE guidance re AF clinic • Main problem-setting up new service • In current “cash strapped times”

  3. AF in 1995

  4. AF in 2011

  5. “So- what happened next ?” • Discussion with trust managers • AF/Fl patients seen in many different settings –NOT new activity • Aiming for consultant led rather than nurse led- WHY ? • - ability to prescribe Class Ic drugs • - refer straight on for DCV/AVN/PVI • -deal with precipitating cardiac issues, if required.

  6. Hurdles to overcome • DLB availability/physiologists • ROOM availability • ECG/24h Tape/ECHO • Development of clinic proforma with IT (and multiple “tweakings”) • Email/Fax (to avoid need for typing) • “letting go” phenomenon

  7. Referral criteria • Newly diagnosed AF or Atrial Flutter • OR AF/Flutter that is difficult to manage. • AF and concern re other procedure • Eg surgery etc

  8. Going Live! • 1st week in January 2011 • 3/12 Pilot Project • ONLY in house referrals-via elective OP referrals/in patient via MAU etc • 4 slots per week • April 2011- end of pilot • Increased to 6 slots per week

  9. Clinic Format • 6 patients 30 minute consultation • All patients have 12 lead ECG/24 H ECG/TTE –unless had in last 3/12 • Patients encouraged to bring someone along with them • Nuances of clinic explained • Work through proforma • Check all understood • AFA booklets/advice sheets

  10. Anticoagulation • CHADS2 and CHADSvasc • Hasbled (if required) • Direct referral to anticoagulation Clinic on same day • AFA advice sheets

  11. DC Cardioversion • Patients requiring DCV • Consented by DLB • Pre-clerking and date for DCV given • “meet and greet” staff on MIU • DCV waiting list

  12. EP referrals • Made same day • Urgent referrals via phone/fax/email • Patients given info on AVN/PVI/Flutter Ablation

  13. Device Referral • 5 patients had VVIR PPM • 2 patients had CRT-P • Others pending after DCV, ablation etc

  14. Admissions • Very rare-from clinic 3 admissions with Aflutter with 2:1 Block for TOE guided DCV If atrial clot- managed appropriately

  15. Miscellaneous • Quality of Life questionnaire • “AFEQT” atrial fibrillation effect in quality of life • Using proforma outside of AF clinic

  16. Demographics • AGE RANGE less than 65y= 52 • (21 F, 31 M) • AGE RANGE 65-75 (15 F, 30 M) • AGE RANGE 0ver 75 (22 F, 24 M)

  17. Demographics • CHADSvasc SCORE 0 =19 • 1 =35 • 2 =28 • 3 =34 • 4 =12 • 5 = 6 • 6 =4

  18. Referrals • DCV 30 • VVIR PPM 5 • EP (all) 7 • Urgent angiogram 2

  19. Anticoagulation at presentation • On ASPIRIN 39% • On WARFARIN 24% • On nothing 46%

  20. “ups and downs” • Increased waiting time due to number of referrals • ?solution- more clinics • AF follow up clinics now running twice monthly • Interest from Stroke practitioners • - stroke/cardiology MDT

  21. “ups and downs” • “glitches” eg:-hold ups with booking • appointments • ECG problems • Avoiding duplication of tests etc • Increased wait for DCV as numbers increase (nurse led at Poole).

  22. Feedback • From patients--- mostly good • “word of mouth referral” • Via Google? • Seeing patients now “cured” • New issue-demand for dabigatran etc • One complaint – • Speedier anticoagulation- re close link with clinic.

  23. Feedback • From GP • Mainly good-constructive • 1 negative (re CHADS score etc) • BUT useful !! • Increased referrals

  24. Other diagnoses • Uncontrolled Thyrotoxicosis • 2 ASD • 3 severe heart failure • 2 mitral valve repairs • Anaemia-not uncommon

  25. Future Plans • Expansion of the clinic-more follow up clinics • Improve AF diagnosis with new monitors • Email clinic letters • Improving DCV waiting times • AUDIT • Etc,etc!

  26. Thank You • Poole AF/Flutter clinic is TEAMWORK • Booking clerks/nurses/reception staff/physiologists/as well as me! • IT for proforma and all adjustments • Patients (putting up with my slow typing!) • AFA booklets and support

More Related