Presentation on theme: "Atrial Fibrillation Service"— Presentation transcript:
1 Atrial Fibrillation Service Jayne WoolleyArrhythmia Specialist NurseRoyal Glamorgan HospitalThis template can be used as a starter file to give updates for project milestones.SectionsSections can help to organize your slides or facilitate collaboration between multiple authors. On the Home tab, under Slides, click Section, and then click Add Section.NotesUse the Notes pane for delivery notes or to provide additional details for the audience. You can see these notes in Presenter View during your presentation.Keep in mind the font size (important for accessibility, visibility, videotaping, and online production)Coordinated colorsPay particular attention to the graphs, charts, and text boxes.Consider that attendees will print in black and white or grayscale. Run a test print to make sure your colors work when printed in pure black and white and grayscale.Graphics, tables, and graphsKeep it simple: If possible, use consistent, non-distracting styles and colors.Label all graphs and tables.
2 Atrial Fibrillation Service In-patient referrals for New onset/Incidental finding AFAdvice and support to medical teamProvision of patient information and counsellingWeekly AF MDT meetingFollow-up clinicsDronedarone – monthly monitoringAnticoagulation/NOAC counselling initiation
3 Atrial fibrillation Service Both Rate/Rhythm control need :Stroke risk assessmentCHADS2 – 0/1 reassess riskCHA2DS2VASc score1 anticoagulation to be considered2 anticoagulation recommended
4 Atrial Fibrillation Service HASBLED scoreHypertennsion(systolic > 160mmHG) pointAbnormal renal/liver function(chronic dialysis/transplantation,serum creatinine >200mmol/Lchronic hepatic disease, bilirubin 2 x upper limitalkaline phosphatase 3 x upper limit 1 point eachStroke pointBleeding pointprevious bleeding history, anaemia etcLiable INR’s point< 60% in theraputic range, unstable high INRsElderly> 65yrs of age pointDrugs/Alcoholconcomitant use of drugs , antiplatelet agents,alcohol abuse point eachSCORE OF >3 HIGH RISK
5 Atrial Fibrillation Service NOAC s for stroke prevention in adults with non-valvular AFwith 1 or more risk factors:Stroke/TIA/Systemic embolismSymptomatic heart failure (NYHA) class >2Left ventricular failure, ejection fraction <40%Age >75 yrsAge >65 plus one of the following:Diabetes mellitus, coronary artery disease or hypertensionDabigatran, Apixaban and RivaroxabanPros: Cons:Lower intercranial haemorrhage No known reversible agentRapid onset/short half life No monitoringNo monitoring Heartburn/bloating/diarrhoeaNo food restrictions % complianceNo alcohol restrictionsLess drug interactions
6 Atrial Fibrillation Service Elective cardioversionReceive referralsArrange anticoagulation and required investigationsRecording weekly INR results (warfarin)Pre-assessment clinicsIf on NOAC declaration is signed by patientCardioversion procedure1 + 6 month follow-up clinics
7 Atrial Fibrillation Service Elective cardioversionevery 4 weeks5-6 patients per list13 currently waitingat least 2 extra lists per year
8 Waiting Times for Cardioversion Min4 WeeksMax12 WeeksLonger if subtheraputic INR
9 Atrial Fibrillation Service Cardioversion April 2013-April 201488 patients listed 2 extras lists82 successful %6 unsuccessful on the day - 7% (rounded up) max 3 shocks delivered, AF in theatre
10 Cancellations and Deferred Patients April 2013 – April 2014 5 – SR on workup/Pre-assessmentDeferred2 – raised TSH (above 10)12 – low INR* If any of these issues caused a schedule delay or need to be discussed further, include details in next slide.
11 Atrial Fibrillation Service Pre/Post cardioversionWeekly INRs 3 weeks beforePreferred range 2.5 to 3.0 (reduced risk of stroke at higherlevel) if INR below 2 in the 3 weeks then they are cancelledWeekly INRs 4 weeks post cardioversionlevel)ESC and NICE state that anticoagulation should continue and not be interrupted for minimum of 4 weeks post cardioversionThromboembolic complications of direct cardioversion are generally related to inadequate intensity of anticoagulation. The INR at the time of conversion is very important. Anticoagulation is necessary for the conversion of atrial flutter as it is for atrial fibrillation. The INR should be 2.5 or more at the time of cardioversion of any atrial arrhythmia that has lasted for more than 2 days.J Am Coll Cardiol 2002