The Atrial Fibrillation Clinic in Llanelli Dr Lena Marie Izzat Consultant Cardiovascular Physician

Llanelli AF Clinic Went live January 2009 Invitations sent to Carmarthenshire catchment area GP’s Open to all physicians, A&E department, CSNs and surgical pre-assessment clinics.

Who is Referred? Newly diagnosed atrial fibrillation where cardiology advice is deemed suitable. Patients with established diagnosis who require specialist input ( PAF or Chronic AF)

Required Assessment prior to Clinic Referral Brief clinical and treatment history Physical examination. ECG essential. FBC / U&E / glucose/ TFT Optional referral for open access echocardiography

At the Clinic CV Risk Factor Assessment (Q Risk) Physical Examination / ECG CHADS II score Referral to anticoagulant clinic if appropriate Referral for Echo if appropriate Management plan and decision on rhythm control or rate control strategy Tertiary centre referral for non-pharmacological management if appropriate Other CV tests arranged if needed (ETT / CAG)

Audit of 222 initial patients Referral Source

Age

CHADS 2 Score N=222 Anticoagulation clinic referrals all seen on day of clinic

Referred for Echo on day of clinic 87% N=222

Diagnosis N=222

Decision N=222

Conclusions Team effort involving physicians, CSNs, cardiac technicians and anticoagulant service. Patients assessed promptly and thoroughly Investigations and anticoagulation decided and often initiated as one-stop. Seamless transfer between departments. Referral to tertiary centre for AF ablation in suitable patients when applicable.

Thank you