A Pulse-Check on Our Health: The Atrial Fibrillation Identification ProjectJanice Throndson1, Céline Tritten1, Joni Kupka1, Dr. Rebecca Purc-Stephenson2 & Cherylyn Antymniuk3

1 Heart and Stroke Clinic, St. Mary’s Hospital, 2 University of Alberta, 3 Site Administrator, St. Mary’s Hospital

• Project included patients older than 18 presenting to the ED between July 2012 – December 2014, where 60 second pulse check was implemented.

• Figure 1. Summary of program algorithm for detecting A-Fib

• The St. Mary’s Hospital (SMH) Heart and Stroke Clinic (H & S Clinic) began the AtrialFibrillation (AFib) Identification Project in July 2012. The A-Fib Identification Project involvesscreening all patients presenting to the emergency department (ED) over the age of 18 forundiagnosed AFib.

• What makes this initiative unique at St. Mary’s Hospital is:

o The first acute care Emergency Department in Alberta to implement the 60second pulse check.

o Our rural hospital setting.o Patients followed throughout continuum of care from detection, investigation,

treatment, recommendations at Heart and Stroke Clinic.o The program is still currently running without dedicated funding since beginning.

Goals of the A-Fib Program:

Stroke prevention

Reduction of system costs

Continuity of Care

Screen all patients over 18 years

Manual 60 sec pulse check

Rhythm Irregular

ECG

Positive for Atrial Fib

Notify ER physician to confirm ECG interpretation

Referral to H&S

CHA2DS2VASC2, anticoag, teaching &

follow-up

Negative for Atrial Fib

Provide Patient with Irregular Heartbeat Information Sheet

SMH Heart and Stroke Clinic notified

Holter ordered, follow up H&S Clinic

Rhythm Regular

No Further action needed. Patient is

reassured.

• The AFib Program at St. Mary’s Hospital provides validity of the 60 second pulse check todetect undiagnosed AFib as well as other potentially life threatening arrhythmias.

• Approximately 3 new cases of AFib are detected each month.• Nearly 25% of all positive AFib cases identified were patients between 18 and 64 years old.• Since continuing this program into 2015, an additional 23 patients have been diagnosed with

A-Fib. Thus, 110 pts have been diagnosed with A-Fib to date (July 2012 – August 2015).• We propose that the 60 second pulse check become standard of care in EDs across Canada.

For more information, please contact Janice Throndson at:Janice.Throndson@covenanthealth.ca

Background & Goals Results

Methods

A highlight of our program outcomes

at SMH

31,359 patients screened

16 urgent Holter results for Cardiology Assessment and

Devices

87 patientsnewly diagnosed with A-Fib

• All newly identified AFib patients are followed in the H & S Clinic and are seen by acardiologist/neurologist and primary physician to commence anticoagulation and A-Fibeducation.

• If Coumadin is indicated, a referral is sent to the Camrose PCN for further INR/anticoagulationteaching.

• All other urgent Holters/abnormal arrhythmias are reviewed by H & S Clinic staff and seen inclinic by a cardiologist for treatment and navigation for intervention, if necessary.

Follow-Up Care

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Conclusions

Figure 4. Number and age of patients identified with an irregular pulse

Figure 3. Patients recommended and taking Holter test

Key Findings of our AFib Program:Helps ensure optimal stroke prevention

Provides continuity of care from ED to H&S clinic

Results in proactive cost reduction

Figure 2. Overview of AFib Program results from St. Mary’s Hospital for the period of July 2012 to December 2014

558 Holters ordered

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18-34 (n = 49) 35-64 (n = 151) 65+ (n = 290)

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male (n = 260)female (n = 230)

Figure 5. Patients who follow-through with Holter test

Figure 7. Patients diagnosed with AFib

Figure 6. Reasons for not following-through with Holter test

23%

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refusednot from areatranferredunable to contactno reason givennot appropriatedeceased

Why some patients might not follow through with testing (from stakeholder interviews):• Lack of understanding – 82% believed

patients simply do not understand the nature and seriousness of condition

• Service access issues – 45% said accessing services could be difficult for patients

• Lack of family physician in area – 36% stated many patients in the community do not have a family physician