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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

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Poole AF/ A Flutter Clinic 2011

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  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

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