Clinician-to-Clinician Update Clinician-to-Clinician Update

Comprehensive Care Enhances Atrial Fibrillation Outcomes

June 2016

Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice. Its prevalence in the United States is reported to be 0.5 to 1%.1 AF is more prevalent among the elderly, and its incidence in the U.S. population is projected to double by the year 2030.2 A serious public health concern, AF puts patients at an increased risk of transient ischemic attack, ischemic stroke, systemic embolism, and death.3, 4

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— Heart specialists Drs. Lin Yee Chen and Scott Sakaguchi confer at the Clinics and Surgery Center. A coordinated care approach helps in the management of AF. Drs. David Benditt and Wayne Adkisson also appear (shown left to right).

Treatment of AF employs strategies to control heart rate or sinus rhythm. Acute AF can be managed with synchronized, direct-current cardioversion, or for patients without hemodynamic instability, rate control can be managed via medication.5 Other treatment options for rate control include atrioventricular node ablation and placement of a permanent pacemaker. Traditional rhythmcontrol strategies have relied upon the use of antiarrhythmic agents as first-line therapy, followed by ablation procedures if first-line pharmacologic measures fail.5 Recent research, however, suggests that the first use of ablation procedures may produce more durable outcomes and better patient quality of life than do antiarrhythmic agents.6 (See Case Study discussion) This is an active area of investigation.

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— Table 1

In the long-term, managing AF symptoms with either rate- or rhythm-control strategies as well as preventing thromboembolism are key goals. Because many risk factors for AF are modifiable (Table 1), aggressive AF risk-reduction strategies, such as the pursuit of weight-loss and fitness goals and medical management of comorbidities, should be incorporated into care plans.7

Management of AF can be complex. To ensure optimal patient outcomes, effective management of the condition requires a coordinated, multidisciplinary, research-based approach and a level of medical and surgical expertise.8 To support and further a comprehensive-care approach to the condition, University of Minnesota Health established its own Atrial Fibrillation Center in January 2016.

References

  1. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285:2370-5.
  2. Colilla S, Crow A, Petkun W, et al. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013;112:1142-7.
  3. Miyasaka Y, et al. Time trends of ischemic stroke incidence and mortality in patients diagnosed with first atrial fibrillation in 1980 to 2000: report of a community-based study. Stroke. 2005;36:2362-2366.
  4. Ruigómez A, et al. Risk of mortality in a cohort of patients newly diagnosed with chronic atrial fibrillation. BMC Cardiovasc Disord. 2002;2:5
  5. Amin A, et al. The current approach of atrial fibrillation management. Avicenna J Med. 2016;6:8-16.
  6. Raatikainen MJ, et al. Radiofrequency catheter ablation maintains its efficacy better than antiarrhythmic medication in patients with paroxysmal atrial fibrillation: On-treatment analysis of the randomized controlled MANTRAPAF trial. Int J Cardiol. 2015;198:108-114.
  7. Miller JD, et al. Obesity, Exercise, obstructive sleep apnea, and modifiable atherosclerotic cardiovascular disease risk factors in atrial fibrillation. J Am Coll Cardiol. 2015;66:2899-2906.
  8. National Clinical Guideline Centre (UK). Atrial Fibrillation: The Management of Atrial Fibrillation. London: National Institute for Health and Care Excellence (UK); 2014 June.

When to refer

The University of Minnesota Health Atrial Fibrillation Center offers evidence-based, state-of-the-art treatment options for patients with atrial fibrillation. Led by Drs. Lin Yee Chen and Huagui Li, the Center provides comprehensive care, placing a strong emphasis on risk-factor mitigation. M Health physicians affiliated with the center are nationally recognized researchers in heart conditions and their treatment and seek to harness new research findings for the benefit of patients.

We encourage healthcare professionals to refer their patients to us early in the disease course when intensive management of cardiovascular risk factors -- such as high blood pressure, obesity, and obstructive sleep apnea--has the best chance of improving atrial fibrillation. Patients who have experienced multiple episodes of atrial fibrillation that required cardioversion or those for whom treatment with antiarrhythmic agents has failed should be referred promptly.

Physicians with the Center are available at our Minneapolis and Edina locations. To schedule a consultation or referral, call 612-365-5000 (877-650-1555 toll free).

Collaborative Care

University of Minnesota Health Heart Care takes a multidisciplinary team approach to each patient’s plan of care. Our team includes cardiologists, cardiac electrophysiologists, cardiac surgeons, advanced practitioners, and cardiac care nurses. We consider the referring physician to be a key member of the care team. We value our relationship with you, your patients, and your office staff. We are available to consult on your patients. After referral, our goal, whenever possible, is to see your patients within seven days if requested. We work hard to keep you informed of your patients’ care by providing detailed reports within a week of each visit, from diagnosis to treatment and follow-up.

Find current clinical trials available through M Health providers here.

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