Atrial Fibrillation - management AF in primary care
|
|
- Briana Harrell
- 8 years ago
- Views:
Transcription
1 Care map information Information resources for patients and carers Updates to this care map Hauora Maori Pacific Clinical presentation AF <48 hours Clinical assessment Assess stroke risk Consider bleeding risk Antithrombotic therapy Referral for echocardiography Consider referral to Cardiology Management in primary care Consider treatment options Rate control treatment Monitor progress Uncontrolled Atrial Fibrillation (AF) Review treatment options Refer to Hospital Cardiology Consider referral to Cardiologist Page 1 of 10
2 1 Care map information The scope of this Pathway This Pathway should be used only for patients in which it will influence the patient management. It is to be used as a guide and doesn't replace clinical judgement. 2 Information resources for patients and carers Patient-centred resources: overview of atrial fibrillation information for patients, family and friends (leaflet) causes and symptoms Medications Patient information about Warfarin. Printable leaflets are available in the following languages: English language leaflet Samoan language leaflet Tongan language leaflet Chinese language leaflet Korean language leaflet Nuiean language leaflet Patient information about Dabigatran Rate/rhythm control medications: beta blockers calcium channel blockers Digoxin Amiodarone Flecainide Language translation assistance: HBDHB Interpreting Service - phone ext 5805 or interpreting@hawkesbaydhb.govt.nz to make an appointment (charges may apply) These websites may help with simple words and phrases: Babelfish Google translate Language Line - professional interpreters are available, free of charge, for telephone-based sessions (44 languages are supported). Phone Monday - Friday 9am - 6pm Saturday 9am - 2pm Bookings are not usually necessary. For longer consultations (for example, a nurse consultation for a newly diagnosed patient) it is best to make a booking at least 24 hours in advance by calling the above number or ing language.line@dia.govt.nz and providing your contact details and a summary of the service you require (time and date of the meeting, language, approximate length of the appointment, gender of interpreter (if relevant). 3 Updates to this care map Page 2 of 10
3 Date of publication: xxx Date of review and republication: XXX This care map has been developed in line with consideration to evidenced based guidelines. For further information on contributors and references please see the Pathway's Provenance Certificate 4 Hauora Maori Maori are a diverse people and whilst there is no single Maori identity, it is vital practitioners offer culturally appropriate care when working with Maori whanau. It is important for practitioners to have a baseline understanding of the issues surrounding Maori health. This knowledge can be actualised by (not in any order of priority): clinicians acknowledging Te Whare Tapa Wha (Maori model of health) when working with Maori whanau asking Maori clients if they would like their whanau or significant others to be involved in assessment and treatment asking Maori clients about any particular cultural beliefs they or their whanau have that might impact on assessment and treatment of the particular health issues consider the importance of introductions and mihimihi ( whanaungatanga ) - a process that enables the exchange of information to support interaction and meaningful connections. This means taking a little time to ask where this person is from or where they have significant connections to. This information is reciprocated; i.e. the health professional also shares where they are from knowledge of the Hawke s Bay health sector s strategies and initiatives for improving Maori health and wellbeing having a historical overview of legislation that has impacted on Maori well-being Training is available through the Hawke s Bay DHB to assist you to better understand Maori culture and to better engage with Maori patients. Contact the coordinator (education@hbdhb.govt.nz) to request details of the next courses. For more information on the regional and national Maori Health Strategies go to: Mai Maori Health Strategy Full file or Summary diagram He Korowai Oranga: Maori Health Strategy - sets the Government s overarching framework to achieving the best health outcomes for Maori. Hawke s Bay District Health Board contracts Maori Providers to deliver breast and cervical screening, and mobile nursing teams. A referral to one of these providers may assist Maori patients to feel more comfortable about receiving these services. Central Hawke s Bay: Central Health - Hastings: Te Taiwhenua o Heretaunga - Kahungunu Health Services (Choices) - Napier: Te Kupenga Hauora - Wairoa: Kahungunu Executive - id=5352&back=searchprovideralphabetical.htm?letter=k&providerid 5 Pacific Pacific people value their culture, language, families, education and their health and wellbeing. Many Pacific families have a religious affiliation to a local church group. The Pacific people are a diverse and dynamic population: more than 22 nations represented in New Zealand each with their own unique culture, language, history, and health status share many similarities which we have shared with you here in order to help you work with Pacific patients more effectively for many families language, cost and access to care are barriers Page 3 of 10
4 Pacific ethnic groups in Hawke's Bay include Samoa, Cook Islands, Fiji, Tonga, Niue, Tokelau, Kiribati and Tuvalu. Samoan and Cook Island groups are the largest and make up two thirds of the total Pacific population. There is a growing trend of inter-ethnic relationships and New Zealand born Pacific populations. Acknowledge The FonoFale Model (Pacific model of health) when working with Pacific peoples and families. General guidelines when working with Pacific peoples and families (information developed by Central PHO, Manawatu): Cultural protocols and greetings Building relationships with your Pacific patients Involving family support and religion during assessments and in the hospital Home visits Hawke s Bay-based resources HBDHB interpreting service ext 5805 (no charge for hospital patients; charges apply for community-based translations) Tim Hutchins- Pacific Navigation Services LTD Services to assist Pacific peoples to access healthcare (SIA) Improving the Health of Pacific People in Hawke s Bay Pacific Health Action Plan Ministry of Health resources: Ala Mo'ui - Pathways to Pacific Health and Wellbeing Primary care for Pacific people: a Pacific and health systems approach Health education resources in Pacific languages (links to a webpage where you can download resources) 6 Clinical presentation Definitions: Persistent Atrial Fibrillation (AF) is characterised by episodes of AF that last more than seven days and that has not spontaneously resolved within this time Permanent AF is characterised by AF that has been present for more than one year and cardioversion has failed or not been attempted Paroxysmal Atrial Fibrillation (AF): is characterised by recurrent episodes of AF that last less than seven days (although often less than 24 hours) and resolve spontaneously within that time 7 AF <48 hours If duration is < 48hrs, then pharmacological or synchronised electrical cardioversion may be considered in secondary care. Although most patients in Atrial Fibrillation (AF) present without haemodynamic compromise, some are significantly compromised and require immediate hospitalisation and urgent intervention to: alleviate symptoms of breathlessness, chest pain, and loss of consciousness restore haemodynamic stability Patients at the greatest risk from haemodynamic instability are those with: a ventricular rate greater than 150bpm ongoing chest pain critical perfusion Refer to Emergency Department for urgent assessment if the person has any of the following: a rapid pulse (greater than 150 bpm) and/or low blood pressure (systolic blood pressure less than 90mmHg) loss of consciousness, severe dizziness, ongoing chest pain, or increasing breathlessness a complication of AF, such as stroke, TIA or acute heart failure 8 Clinical assessment Page 4 of 10
5 When reviewing established Atrial Fibrillation (AF) [3]: check for ongoing symptoms, both at rest and upon exercise assess heart rate (apex rate by auscultation or ECG and radial pulse rate) check for complications of AF (eg Heart failure) and assess BP a baseline ECG chest xray thyroid function test 9 Assess stroke risk Stroke risk [3]: Atrial Fibrillation (AF) is an independent risk factor for stroke the annual risk for stroke is 5-6 times higher in people with AF than in people in sinus rhythm Stroke that occurs in association with AF is also more likely to result in greater mortality, morbidity, disability, and longer hospital stays than stroke in people without AF Risk should be reassessed [3]: if patient develops diabetes, hypertension or cardiovascular disease when patient reaches age 65 and 75 years The European Society of Cardiology (ESC) recommends using the CHA 2 DS 2 VASc score for a more detailed and comprehensive stroke risk assessment [2] see CHADS VASc Score 10 Consider bleeding risk The European Society of Cardiology (ESC) recommends using the HAS-BLED bleeding risk score [2], see HAS-BLED Bleeding Risk Score 11 Antithrombotic therapy Antithrombotic therapy is recommended for all patients with Atrial Fibrillation (AF) unless either [2]: patient is at low risk (eg lone AF, age less than 65 years); or contraindications are present (eg inability to cope with anticoagulation monitoring) The absolute benefit of antithrombotic therapy, eg warfarin or dabigatran for stroke prevention increases with age [2]. AF patients age 75 years and older (even with no other associated risk factors) have a significant stroke risk and derive benefit from warfarin or dabigatran over aspirin [2]. See antithrombotic therapy recommendations based on the CHA 2 DS 2 VASc scoring system. Cultural considerations: There are numerous accounts of the anti-platelet effects of kawakawa. Clinicians need to ensure they have asked Maori clients if they are using any Rongoa Maori (Rongoa Maori encompasses herbal remedies, physical therapies and spiritual healing). Management Options for Primary Care Initiated Anticoagulation Novel oral anticoagulants offer the benefit of fixed dosing regimes with no requirement for blood testing or the need for care with diet. The following need to be considered: dose adjustment in people with creatinine clearance of less than 50 ml/min contraindicated in creatinine clearance of less than 30 ml/min Patient information about Dabigatran Warfarin therapy: Page 5 of 10
6 General practice may choose to manage the initiation of warfarin therapy and ongoing dosing management. Once a patient is stable on anticoagulation medication, on-going INR monitoring may be conducted at selected community pharmacies. Please contact the selected pharmacy to arrange ongoing INR monitoring. Patients should be contacted by the GP practice or testing pharmacy after each INR test to provide: their result the date of their next INR their warfarin dose See guide for initiation of low dose warfarin therapy add link Patient information about Warfarin. Printable leaflets are available in the following languages: English language leaflet Samoan language leaflet Tongan language leaflet Chinese language leaflet Korean language leaflet Nuiean language leaflet Marevan and Coumarin are available in NZ Marevan accounts for approximately 95% of prescriptions of warfarin in NZ the brands are not interchangeable and come in different tablet strengths during community initiation only 1mg tablets should be used to minimise confusion attach the following note to patients first prescription requesting pharmacist counselling and information on oral anticoagulant use Anticoagulant Prescription Attachment NB: Stroke risk factors have a cumulative effect on overall stroke risk. For example, if the patient is in the moderate stroke risk category but has more than one risk factor for stroke, e.g. hypertension and diabetes, there may be a stronger case for choosing warfarin over aspirin [1]: if warfarin or dabigatran is offered, aspirin should not usually be taken concomitantly, as it provides no additional benefit and may increase the risk of bleeding [1] if stroke risk is uncertain, start aspirin whilst awaiting cardiology assessment [1] for patients with AF who have mechanical heart valves, it is recommended that the target intensity of anticoagulation should be based on the type and position of the prosthesis, maintaining an INR of at least 2.5 in the mitral position and at least 2.0 for an aortic valve [2] the selection of antithrombotic therapy should be considered using the same criteria irrespective of the pattern of AF (ie paroxysmal, persistent or permanent [2] NB: The use of clopidogrel or a combination of aspirin and clopidogrel are not recommended for managing AF in primary care [3]. 12 Referral for echocardiography Strongly recommended transthoracic echocardiography (TTE) if [1]: there is a risk or suspicion of underlying heart disease, eg signs of heart failure or cardiac murmur [3] information on cardiac structure or function is needed to make a decision about starting antithrombotic treatment TTE may help to clarify risk of stroke in some patients, eg those with suspected left ventricular dysfunction without overt heart failure [3] 13 Consider referral to Cardiology Consider a referral to the Cardiologist: Page 6 of 10
7 patients in whom rhythm control including cardioversion is considered patients whose rate control is poor patients whose symptoms cannot be controlled patients with abnormal ECG or echocardiogram patients who have contraindication or intolerance of standard rate control therapies Direct referral to Echocardiography: patients with new AF where a scan would influence management 14 Management in primary care Both rhythm control and rate control are acceptable strategies in the management of Atrial Fibrillation (AF). Rate control is needed for many patients with AF unless the heart rate during AF is naturally slow. Rhythm control may be considered in preference to rate control, if: the patient is symptomatic despite adequate rate control; or a rhythm control strategy is selected due to: the degree of symptoms younger age higher activity levels Permanent AF is managed by rate control. The initial therapy after onset of AF should always include adequate antithrombotic treatment and control of the ventricular rate. Rate control can be started in primary care, but rhythm control should only be started following specialist assessment. Refer to cardiologist for rhythm control treatment if patient: is symptomatic is aged 65 years or younger presents for the first time with lone AF, indicated by: no history of cardiovascular disease or hypertension no abnormal cardiac signs on physical examination a normal chest x-ray and, apart from the presence of AF, a normal ECG ie no indication of prior myocardial infarction or left ventricular hypertrophy presents with AF secondary to a treated or corrected precipitant, e.g. infection Rate control may be the preferable initial strategy in patients [1]: with permanent AF over age 65 years with coronary heart disease who have contraindications to antiarrhythmic drugs with contraindications to cardioversion, such as: AF of more than 12 months duration several previous failed attempts at cardioversion structural disease precluding long-term maintanence of sinus rhythm, eg mitral stenosis with contraindications to anticoagulation If there is uncertainty about which option is best, seek specialist advice. Also refer to a cardiologist (for either rhythm or rate control) if: rate control medication that can be administered in primary care is contraindicated patient has been prescribed rhythm control treatment in secondary care and presents with persistent or recurring symptoms 15 Consider treatment options Page 7 of 10
8 Consider rate control treatment if either of the following apply [3]: resting heart rate is persistently 100 beats per minute or more heart rate is fast on exertion, resulting in limited exercise tolerance 16 Rate control treatment The ventricular rate may be controlled using: beta blockers rate limiting calcium channel blockers (verapamil or diltiazem) or digoxin (third line treatment) The choice of a medicine for rate control in primary care should be guided by the presence of co-morbidities and also by the level of activity of the patient. See Rate Control Medication As a guide, target heart rate should be 100 beats per minute at rest and 115 beats per minute with moderate walking. Seek Cardiologist advice if there is uncertainty over whether to prescribe medication and/or if patients continue to experience symptoms related to Atrial Fibrillation (AF) during activity [3]. 17 Monitor progress Follow-up within 1 week [3]. Check whether the patient is tolerating the medication if the patient is unable to tolerate the current medication, prescribe an alternative. Review symptoms, heart rate, and blood pressure. 18 Uncontrolled Atrial Fibrillation (AF) As a guide, target heart rate should be 100 beats per minute at rest and 120 beats per minute with moderate walking. Seek Cardiologist advice if there is uncertainty over whether to prescribe medication and/or if patients continue to experience symptoms related to Atrial Fibrillation (AF) during activity [3]. 19 Review treatment options If the patient's symptoms and/or heart rate are not controlled, consider increasing the dose to control symptoms. If the patient is taking the maximum drug dose, consider combining drug treatments. See recommended rate control medications Rate Control Medication 21 Consider referral to Cardiologist Refer to a Cardiologist if symptoms are not controlled with, or patient does not tolerate, a beta-blocker plus digoxin, or a calcium channel blocker plus digoxin [3] A Cardiologist may consider/recommend the use of [1]: amiodarone diltiazem with a beta-blocker Page 8 of 10
9 Alternatively, a Cardiologist may consider a non-pharmacological approach, such as atrioventricular node ablation coupled with pacing [3]. Page 9 of 10
10 Key Dates Published:, by Valid until: Evidence summary for Atrial Fibrillation - management AF in primary care Page 10 of 10
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF)
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) Key priorities Identification and diagnosis Treatment for persistent AF Treatment for permanent AF Antithrombotic
More informationAtrial fibrillation. Quick reference guide. Issue date: June 2006. The management of atrial fibrillation
Quick reference guide Issue date: June 2006 Atrial fibrillation The management of atrial fibrillation Developed by the National Collaborating Centre for Chronic Conditions Contents Contents Patient-centred
More informationAtrial Fibrillation An update on diagnosis and management
Dr Arvind Vasudeva Consultant Cardiologist Atrial Fibrillation An update on diagnosis and management Atrial fibrillation (AF) remains the commonest disturbance of cardiac rhythm seen in clinical practice.
More informationACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY
Care Pathway Triage category ATRIAL FIBRILLATION PATHWAY ACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY AF/ FLUTTER IS PRIMARY REASON FOR PRESENTATION YES NO ONSET SYMPTOMS OF AF./../ TIME DURATION OF AF
More informationTreating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC
Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG
More informationManagement of ATRIAL FIBRILLATION. in general practice. 22 BPJ Issue 39
Management of ATRIAL FIBRILLATION in general practice 22 BPJ Issue 39 What is atrial fibrillation? Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in primary care. It is often
More informationAtrial Fibrillation. Information for you, and your family, whänau and friends. Published by the New Zealand Guidelines Group
Atrial Fibrillation Information for you, and your family, whänau and friends Published by the New Zealand Guidelines Group CONTENTS Introduction 1 The heart 2 What is atrial fibrillation? 3 How common
More informationProtocol for the management of atrial fibrillation in primary care
Protocol for the management of atrial fibrillation in primary care Protocol for the management of atrial fibrillation in primary care Contents Page no Definition 2 Classification of AF 2 3 Identification
More informationNational Medicines Information Centre
National Medicines Information Centre ST. JAMES S HOSPITAL DUBLIN 8 TEL 01-4730589 or 1850-727-727 FAX 01-4730596 www.nmic.ie THE CONTEMPORARY MANAGEMENT OF ATRIAL FIBRILLATION VOLUME 12 NUMBER 3 2006
More informationHERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below
Name: generic (trade) Rivaroxaban (Xarelto ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below What it is Indications
More informationNORTHERN NETWORK OF CARDIAC CARE GUIDELINES FOR THE DETECTION AND MANAGEMENT OF ATRIAL FIBRILLATION (AF)
NORTHERN NETWORK OF CARDIAC CARE GUIDELINES FOR THE DETECTION AND MANAGEMENT OF ATRIAL FIBRILLATION (AF) These notes should be read in conjunction with the summary algorithms July 2007 CONTENTS 1. Introduction
More informationTreatments to Restore Normal Rhythm
Treatments to Restore Normal Rhythm In many instances when AF causes significant symptoms or is negatively impacting a patient's health, the major goal of treatment is to restore normal rhythm and prevent
More informationPalpitations & AF. Richard Grocott Mason Consultant Cardiologist THH NHS Foundation Trust & Royal Brompton & Harefield NHS Foundation Trust
Palpitations & AF Richard Grocott Mason Consultant Cardiologist THH NHS Foundation Trust & Royal Brompton & Harefield NHS Foundation Trust Palpitations Frequent symptom Less than 50% associated with arrhythmia
More informationNICE clinical guideline 180: Atrial fibrillation Prescribing and medicines optimisation issues
NICE clinical guideline 180: Atrial fibrillation Prescribing and medicines optimisation issues Andy Hutchinson Medicines Education Technical Adviser NICE Medicines and Prescribing Centre Note: this is
More informationSTROKE PREVENTION IN ATRIAL FIBRILLATION
STROKE PREVENTION IN ATRIAL FIBRILLATION OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention of ischemic stroke and arterial thromboembolism in patients
More informationAtrial Fibrillation (AF) Explained
James Paget University Hospitals NHS Foundation Trust Atrial Fibrillation (AF) Explained Patient Information Contents What are the symptoms of atrial fibrillation (AF)? 3 Normal heartbeat 4 How common
More informationATRIAL FIBRILLATION IN THE 21 ST CENTURY TIMOTHY DOWLING, D.O. FAMILY PHYSICIAN
ATRIAL FIBRILLATION IN THE 21 ST CENTURY TIMOTHY DOWLING, D.O. FAMILY PHYSICIAN GOALS AND OBJECTIVES At The end of this talk you should understand: What is Atrial Fibrillation Causes of Atrial Fibrillation
More informationAtrial Fibrillation Peter Santucci, MD Revised May, 2008
Atrial Fibrillation Peter Santucci, MD Revised May, 2008 Atrial fibrillation (AF) is an irregular, disorganized rhythm characterized by a lack of organized mechanical atrial activity. The atrial rate is
More information9/5/14. Objectives. Atrial Fibrillation (AF)
Novel Anticoagulation for Prevention of Stroke in Patients with Atrial Fibrillation Objectives 1. Review current evidence on use of warfarin in individuals with atrial fibrillation 2. Compare the three
More informationAtrial Fibrillation Based on ESC Guidelines. Moshe Swissa MD Kaplan Medical Center
Atrial Fibrillation Based on ESC Guidelines Moshe Swissa MD Kaplan Medical Center Epidemiology AF affects 1 2% of the population, and this figure is likely to increase in the next 50 years. AF may long
More informationRecurrent AF: Choosing the Right Medication.
In the name of God Shiraz E-Medical Journal Vol. 11, No. 3, July 2010 http://semj.sums.ac.ir/vol11/jul2010/89015.htm Recurrent AF: Choosing the Right Medication. Basamad Z. * Assistant Professor, Department
More informationCardioversion for. Atrial Fibrillation. Your Heart s Electrical System Cardioversion Living with Atrial Fibrillation
Cardioversion for Atrial Fibrillation Your Heart s Electrical System Cardioversion Living with Atrial Fibrillation When You Have Atrial Fibrillation You ve been told you have a heart condition called atrial
More informationManaging the Patient with Atrial Fibrillation
Pocket Guide Managing the Patient with Atrial Fibrillation Updated April 2012 Editor Stephen R. Shorofsky, MD, Ph.D. Assistant Editors Anastasios Saliaris, MD Shawn Robinson, MD www.hrsonline.org DEFINITION
More informationCurrent Management of Atrial Fibrillation DISCLOSURES. Heart Beat Anatomy. I have no financial conflicts to disclose
Current Management of Atrial Fibrillation Mary Macklin, MSN, APRN Concord Hospital Cardiac Associates DISCLOSURES I have no financial conflicts to disclose Book Women: Fit at Fifty. A Guide to Living Long.
More informationFOR THE PREVENTION OF ATRIAL FIBRILLATION RELATED STROKE
www.bpac.org.nz keyword: warfarinaspirin FOR THE PREVENTION OF ATRIAL FIBRILLATION RELATED STROKE Key Concepts In atrial fibrillation (AF) warfarin is more effective than aspirin for stroke prevention.
More informationDorset Cardiac Centre
P a g e 1 Dorset Cardiac Centre Patients with Atrial Fibrillation/Flutter undergoing DC Cardioversion or Ablation procedures- Guidelines for Novel Oral Anti-coagulants (NOACS) licensed for this use February
More informationAtrial Fibrillation: Drugs, Ablation, or Benign Neglect. Robert Kennedy, MD October 10, 2015
Atrial Fibrillation: Drugs, Ablation, or Benign Neglect Robert Kennedy, MD October 10, 2015 Definitions 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary.
More informationAtrial Fibrillation Management Across the Spectrum of Illness
Disclosures Atrial Fibrillation Management Across the Spectrum of Illness NONE Barbara Birriel, MSN, ACNP-BC, FCCM The Pennsylvania State University Objectives AF Discuss the pathophysiology, diagnosis,
More informationAnticoagulants in Atrial Fibrillation
Anticoagulants in Atrial Fibrillation Starting and Stopping Them Safely Carmine D Amico, D.O. Overview Learning objectives Introduction Basic concepts Treatment strategy & options Summary 1 Learning objectives
More informationSTROKE PREVENTION IN ATRIAL FIBRILLATION. TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: ABBREVIATIONS: BACKGROUND:
STROKE PREVENTION IN ATRIAL FIBRILLATION TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention
More informationNew Treatments for Stroke Prevention in Atrial Fibrillation. John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013
New Treatments for Stroke Prevention in Atrial Fibrillation John C. Andrefsky, MD, FAHA NEOMED Internal Medicine Review course May 5 th, 2013 Classification Paroxysmal atrial fibrillation (AF) Last < 7
More informationAtrial fibrillation: medicines to help reduce your risk of a stroke what are the options?
Patient decision aid Atrial fibrillation: medicines to help reduce your risk of a stroke what are the options? http://guidance.nice.org.uk/cg180/patientdecisionaid/pdf/english Published: June 2014 About
More information2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY
Measure #326 (NQF 1525): Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS,
More informationINFORMATION FOR PATIENTS AND FAMILIES A Patient s Guide to Living with Atrial Fibrillation
INFORMATION FOR PATIENTS AND FAMILIES A Patient s Guide to Living with Atrial Fibrillation 30 Bond Street, Toronto, ON M5B 1W8 Canada 416.864.6060 stmichaelshospital.com Form No. XXXXX Dev. XX/XXXX GOALS
More informationA Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation
Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation A Patient s Guide to Antithrombotic Therapy in Atrial Fibrillation PATIENT EDUCATION GUIDE What is atrial fibrillation? Atrial fibrillation
More informationAtrial Fibrillation (AF) March, 2013
Atrial Fibrillation (AF) March, 2013 This handout is meant to help with discussions about the condition, and it is not a complete discussion of AF. We hope it will complement your appointment with one
More informationATRIAL FIBRILLATION (RATE VS RHYTHM CONTROL)
ATRIAL FIBRILLATION (RATE VS RHYTHM CONTROL) By Prof. Dr. Helmy A. Bakr Mansoura Universirty 2014 AF Classification: Mechanisms of AF : Selected Risk Factors and Biomarkers for AF: WHY AF? 1. Atrial fibrillation
More informationPrevention of stroke in patients with atrial fibrillation
www.sign.ac.uk Prevention of stroke in patients with atrial fibrillation A guide for primary care January 2014 Evidence Contents 1 Introduction... 1 2 Detection...2 3 Risk stratification... 3 4 Treatment
More informationA PATIENT S GUIDE TO STROKE AND ATRIAL FIBRILLATION (AF)
A PATIENT S GUIDE TO STROKE AND ATRIAL FIBRILLATION (AF) This medicine is subject to additional monitoring. This will allow quick identification of new safety information. If you get any side effects,
More informationQuiz 4 Arrhythmias summary statistics and question answers
1 Quiz 4 Arrhythmias summary statistics and question answers The correct answers to questions are indicated by *. All students were awarded 2 points for question #2 due to no appropriate responses for
More informationEpisode 20 Atrial fibrillation Prepared by Dr. Lucas Chartier
Episode 20 Atrial fibrillation Prepared by Dr. Lucas Chartier Most common dysrhythmia seen in ED, and incidence increasing with ageing population Presentation Common presentations: younger patients often
More informationAtrial Fibrillation and Anticoagulants
York Teaching Hospital NHS Foundation Trust Atrial Fibrillation and Anticoagulants A guide to your diagnosis and treatment Information for patients, relatives and carers For more information, please contact:
More informationDifficult Cases in Atrial Fibrillation. Ascot Cardiology GP Symposium April 2014
Difficult Cases in Atrial Fibrillation Ascot Cardiology GP Symposium April 2014 Atrial Fibrillation 1-2% general population 40-50yrs
More informationSurvey of Canadian Physicians Use of anti-thrombotic therapy for Atrial Fibrillation
Survey of Canadian Physicians Use of anti-thrombotic therapy for Atrial Fibrillation On the following pages are a number of questions asking about the conditions under which you would prescribe anticoagulation
More informationRATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY. Charles Jazra
RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION: SPECIAL CONSIDERATION IN ELDERLY Charles Jazra NO CONFLICT OF INTEREST TO DECLARE Relationship Between Atrial Fibrillation and Age Prevalence, percent
More informationNgaire has Palpitations
Ngaire has Palpitations David Heaven Cardiac Electrophysiologist/Heart Rhythm Specialist Middlemore, Auckland City and Mercy Hospitals Auckland Heart Group MCQ Ms A is 45, and a healthy marathon runner.
More informationTABLE 1 Clinical Classification of AF. New onset AF (first detected) Paroxysmal (<7 days, mostly < 24 hours)
Clinical Practice Guidelines for the Management of Patients With Atrial Fibrillation Deborah Ritchie RN, MN, Robert S Sheldon MD, PhD Cardiovascular Research Group, University of Calgary, Alberta Partly
More informationThe author has no disclosures
Mary Bradbury, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Surgery September 18, 2012 Mary.bradbury@inova.org This presentation will discuss unlabeled and investigational use of products The author
More informationAtrial Fibrillation Centre
About this guide We have prepared this guide to help you to: learn about atrial fibrillation manage atrial fibrillation and reduce the risk of stroke find out about medicines and other treatment options
More informationDabigatran: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF
Leeds Dabigatran: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Amber Drug Level 3 (amber drug with monitoring requirements) We have started your
More informationNICE TA 275: Apixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation
Service Notification in response to DHSSPS endorsed NICE Technology Appraisals NICE TA 275: Apixaban for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation 1
More informationAtrial Fibrillation The Basics
Atrial Fibrillation The Basics Family Practice Symposium Tim McAveney, M.D. 10/23/09 Objectives Review the fundamentals of managing afib Discuss the risks for stroke and the indications for anticoagulation
More informationMedical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South
Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains
More informationAtrial fibrillation (non-valvular) and reducing the risk of a stroke Management Options Brief Decision Aid
Atrial fibrillation (non-valvular) and reducing the risk of a stroke Management Options Brief Decision Aid Atrial fibrillation (AF) increases your risk of having a stroke (a blood clot in the brain). From
More informationATRIAL FIBRILLATION: Scope of the Problem. October 2015
ATRIAL FIBRILLATION: Scope of the Problem October 2015 Purpose of the Presentation Review the worldwide incidence and prognosis associated with atrial fibrillation (AF) Identify the types of AF, clinical
More informationAtrial Fibrillation. Patient Information. 828361 Dec 19-12
Atrial Fibrillation Patient Information 828361 Dec 19-12 Contents Introduction 1 Treatment & decrease stroke options 2 Information for people who are taking warfarin (Coumadin ) 5 Information for people
More informationPHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES.
PHARMACOLOGICAL Stroke Prevention in Atrial Fibrillation STROKE RISK ASSESSMENT SCORES Vs. BLEEDING RISK ASSESSMENT SCORES. Hossam Bahy, MD (1992 2012), 19 tools have been identified 11 stroke scores 1
More informationNOAC Prescribing in Patients with Non-Valvular Atrial Fibrillation: Frequently Asked Questions
AC Prescribing in Patients with Non-Valvular Atrial Fibrillation: Frequently Asked Questions FAQ document jointly prepared by NHSGGC Haematology Service & Medicines Infmation On behalf of the Heart MCN
More informationPRACTICAL APPROACH TO SVT. Graham C. Wong MD MPH Division of Cardiology Vancouver General Hospital University of British Columbia
PRACTICAL APPROACH TO SVT Graham C. Wong MD MPH Division of Cardiology Vancouver General Hospital University of British Columbia CONDUCTION SYSTEM OF THE HEART SA node His bundle Left bundle AV node Right
More informationAtrial Fibrillation, Chronic - Antithrombotic Treatment - OBSOLETE
Atrial Fibrillation, Chronic - Antithrombotic Treatment - OBSOLETE Clinical practice guidelines serve as an educational reference, and do not supersede the clinical judgment of the treating physician with
More informationBlood thinning (anticoagulation) in atrial fibrillation (AF)
AF A Blood thinning (anticoagulation) in atrial fibrillation (AF) Providing information, support and access to established, new or innovative treatments for atrial fibrillation www.afa.org.uk Registered
More informationAtrial fibrillation (AF) patient information
AF A Atrial fibrillation (AF) patient information Providing information, support and access to established, new or innovative treatments for Atrial Fibrillation www.atrialfibrillation-au.org Glossary Antiarrhythmic
More informationHow to control atrial fibrillation in 2013 The ideal patient for a rate control strategy
How to control atrial fibrillation in 2013 The ideal patient for a rate control strategy L. Pison, MD Advances in Cardiac Arrhythmias and Great Innovations in Cardiology - Torino, September 28 th 2013
More informationAppendix C Factors to consider when choosing between anticoagulant options and FAQs
Appendix C Factors to consider when choosing between anticoagulant options and FAQs Choice of anticoagulant for non-valvular* atrial fibrillation: Clinical decision aid Patients should already be screened
More informationNovartis Gilenya FDO Program Clinical Protocol and Highlights from Prescribing Information (PI)
Novartis Gilenya FDO Program Clinical Protocol and Highlights from Prescribing Information (PI) Highlights from Prescribing Information - the link to the full text PI is as follows: http://www.pharma.us.novartis.com/product/pi/pdf/gilenya.pdf
More informationThe debate: Should all AF patients see an EP consultant?
The debate: Should all AF patients see an EP consultant? Pre-debate show of hands in favour of the motion The argument for the motion: Dr Nick Kelland The argument against the motion: Dr Andy McCoye Discussion
More informationAntiplatelet and Antithrombotic Therapy. Dr Curry Grant Stroke Prevention Clinic Quinte Health Care
Antiplatelet and Antithrombotic Therapy Dr Curry Grant Stroke Prevention Clinic Quinte Health Care Disclosure of Potential for Conflict of Interest Dr. F.C. Grant Atrial Fibrillation FINANCIAL DISCLOSURE:
More informationIntroduction to Atrial Fibrillation (AFib)
Introduction to Atrial Fibrillation (AFib) Learn About: 1. What is atrial fibrillation? 2. How will I feel? 3. Who gets AFib? 4. Risk of stroke 5. AFib treatment 6. How to live well with AFib 1. What is
More informationATRIAL FIBRILLATION IN PRIMARY CARE (AFIP)
ATRIAL FIBRILLATION IN PRIMARY CARE (AFIP) BRINGING ATRIAL FIBRILLATION PRACTICE CLOSER TO GUIDELINES A Tool for Primary Care Physicians INTERNATIONAL www.afa-international.org CONTENTS: Introducing the
More informationSign up to receive ATOTW weekly - email wfsahq@anaesthesiologists.org
ATRIAL FIBRILLATION (AF). PERI-OPERATIVE MANAGEMENT FOR NON-CARDIAC SURGERY ANAESTHESIA TUTORIAL OF THE WEEK 307 28 th APRIL 2014 Dr J Sokhi Southend University Hospital, UK Professor J Kinnear Southend
More informationwww.irishheart.ie ATRIAL FIBRILLATION AND YOU An information booklet for people living with Atrial Fibrillation (a type of irregular heart beat).
www.irishheart.ie ATRIAL FIBRILLATION AND YOU An information booklet for people living with Atrial Fibrillation (a type of irregular heart beat). Contents Introduction 5 Produced by the Irish Heart Foundation
More informationTraditionally, the goal of atrial fibrillation (AF)
358 Clinical Pharmacist November 2010 Vol 2 Treatment of atrial fibrillation usually involves controlling ventricular rate or restoring sinus rhythm. Equally important is thromboembolic risk assessment
More informationNHS DORSET CLINICAL COMMISSIONING GROUP POSITION STATEMENT ON ORAL ANTICOAGULANTS IN ATRIAL FIBRILLATION
Version 3 August 2014 NHS DORSET CLINICAL COMMISSIONING GROUP POSITION STATEMENT ON ORAL ANTICOAGULANTS IN ATRIAL FIBRILLATION Dorset CCG commissions the use of newer oral anti-coagulants in accordance
More informationThe Emerging Atrial Fibrillation Epidemic: Treat It, Leave It or Burn It?
The Emerging Atrial Fibrillation Epidemic: Treat It, Leave It or Burn It? Indiana Chapter-ACC 17 th Annual Meeting Indianapolis, Indiana October 19, 2013 Deepak Bhakta MD FACC FACP FAHA FHRS CCDS Associate
More informationAtrial Fibrillation Cardiac rate control or rhythm control could be the key to AF therapy
Cardiac rate control or rhythm control could be the key to AF therapy Recent studies have proven that an option of pharmacologic and non-pharmacologic therapy is available to patients who suffer from AF.
More informationAtrial fibrillation (AF) care pathways. for the primary care physicians
Atrial fibrillation (AF) care pathways for the primary care physicians by University of Minnesota Physicians Heart, October, 2011 Evaluation by the primary care physician: 1. Comprehensive history and
More informationUHS CLINICAL CARE COLLABORATION: Outpatient & Inpatient
Guidelines for Anticoagulation Initiation and Management Y2014 UHS CLINICAL CARE COLLABORATION: Outpatient & Inpatient Topic Page Number MEDICATION FLOW AND PATIENT FLOW... 2 AND 3 PARENTERAL ANTICOAGULANTS...
More informationUpdates to the Alberta Human Services Drug Benefit Supplement
Updates to the Alberta Human Services Drug Benefit Supplement Effective January 1, 2016 Inquiries should be directed to: Pharmacy Services Alberta Blue Cross 10009 108 Street NW Edmonton AB T5J 3C5 Telephone
More informationService Specification Template Department of Health, updated June 2015
Service Specification Template Department of Health, updated June 2015 Service Specification No. : 2 Service: Commissioner Lead: Provider Lead: Period: Anti-coagulation monitoring Date of Review: 31 st
More informationRivaroxaban shared care guidelines for the prevention of stroke and embolism in adult patients with nonvalvular atrial fibrillation.
South West Essex Rivaroxaban Shared Care Guideline (SCG) Rivaroxaban shared care guidelines for the prevention of stroke and embolism in adult patients with nonvalvular atrial fibrillation. Introduction
More informationThree new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008:
Key Points to consider when prescribing NOACs Introduction Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008: Dabigatran Etexilate (Pradaxa ) 75mg, 110mg, 150mg. Rivaroxaban
More informationAll Wales Risk/Benefit Assessment Tool for Oral Anticoagulant Treatment in People with Atrial Fibrillation
All Wales Risk/Benefit Assessment Tool for Oral Anticoagulant Treatment in People with Atrial Fibrillation October 2013 This report has been prepared by a multiprofessional collaborative group, with support
More informationAddendum to the Guideline on antiarrhythmics on atrial fibrillation and atrial flutter
22 July 2010 EMA/CHMP/EWP/213056/2010 Addendum to the Guideline on antiarrhythmics on atrial fibrillation and atrial flutter Draft Agreed by Efficacy Working Party July 2008 Adoption by CHMP for release
More informationKevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013
Kevin Saunders MD CCFP Rivergrove Medical Clinic Wellness Institute @ SOGH April 17 2013 Family physician with Rivergrove Medical Clinic Practice in the north end since 1985 Medical Director of the Wellness
More informationBreakfast symposium: From hospital to home - the focus on the patient
Breakfast symposium: From hospital to home - the focus on the patient Nadya Hamedi DARZI Fellow UCLPartners and Barts Health NHS Trust in collaboration with North Central London Local Pharmaceutical Committee
More informationUpdates to the Alberta Drug Benefit List. Effective January 1, 2016
Updates to the Alberta Drug Benefit List Effective January 1, 2016 Inquiries should be directed to: Pharmacy Services Alberta Blue Cross 10009 108 Street NW Edmonton AB T5J 3C5 Telephone Number: (780)
More informationNovel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations
Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations Dardo E. Ferrara MD Cardiac Electrophysiology North Cascade Cardiology PeaceHealth Medical Group Which anticoagulant
More informationrivaroxaban 15 and 20mg film-coated tablets (Xarelto ) SMC No. (756/12) Bayer PLC
rivaroxaban 15 and 20mg film-coated tablets (Xarelto ) SMC No. (756/12) Bayer PLC 13 January 2012 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS
More informationRedefining the NSTEACS pathway in London
Redefining the NSTEACS pathway in London Sotiris Antoniou Consultant Pharmacist, Cardiovascular Medicine, Barts and The London NHS Trust and Project Lead, North East London Cardiovascular and Stroke Network
More informationAtrial fibrillation/flutter: When to refer, What tests, What meds
Atrial fibrillation/flutter: When to refer, What tests, What meds Warren Smith Green Lane Cardiovascular Service Auckland City Hospital, Auckland, New Zealand Why might it not be a good idea to cardiovert
More informationGRASP-AF Coming to a PCT near you.
GRASP-AF Coming to a PCT near you. ADAS Anticoagulation dosing advisory service Blackpool Teaching Hospitals Trust Sean O'Brien; Anticoagulation Specialist BMS Grasp-AF and the implications on our Anticoagulation
More informationNon- Valvular Atrial Fibrillation and Stroke Prevention: Which OAC Do I Choose. Warfarin vs the NOACs
Non- Valvular Atrial Fibrillation and Stroke Prevention: Which OAC Do I Choose Warfarin vs the NOACs Dr. Lori McIntosh D.O. Board Certified Neurologist Objectives Be able to list the current options of
More informationTHE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT
THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological
More informationAtrial Fibrillation The High Risk Obese Patient
Atrial Fibrillation The High Risk Obese Patient Frederick Schaller, D.O.,F.A.C.O.I. Professor and Vice Dean Touro University Nevada A 56 year old male with a history of hypertension and chronic stable
More informationRx Updates New Guidelines, New Medications What You Need to Know
Rx Updates New Guidelines, New Medications What You Need to Know Maria Pruchnicki, PharmD, BCPS, BCACP, CLS Associate Professor of Clinical Pharmacy OSU College of Pharmacy Background scope and impact
More informationAtrial Fibrillation: Stroke and Thromboprophylaxis. Derek Waller
Atrial Fibrillation: Stroke and Thromboprophylaxis Derek Waller Atrial Fibrillation in the Elderly: Risk of Stroke Framingham study AGE 50-59 60-69 70-79 80-89 Prevalence of AF % Attributable Risk of AF
More informationAtrial Fibrillation: Do We Have A Cure? Raymond Kawasaki, MD AMG Electrophysiology February 21, 2015
Atrial Fibrillation: Do We Have A Cure? Raymond Kawasaki, MD AMG Electrophysiology February 21, 2015 Disclaimer I have no relationships to disclose Do we have a cure for Atrial Fibrillation? The short
More informationTackling the Semantic Interoperability challenge
European Patient Summaries: What is next? Tackling the Semantic Interoperability challenge Dipak Kalra Cross-border health care The context for sharing health summaries Also useful for within-border health
More informationAtrial Fibrillation and Ablation Therapy: A Patient s Guide
Atrial Fibrillation and Ablation Therapy: A Patient s Guide ATRIAL FIBRILLATION CENTER AT UNIVERSITY OF ROCHESTER MEDICAL CENTER www.heart.urmc.edu 585-275-4775 INTRODUCTION Our goal at the Atrial Fibrillation
More informationCosts and Benefits of Antithrombotic Therapy in Atrial Fibrillation in England: An Economic Analysis based on GRASP-AF
Costs and Benefits of Antithrombotic Therapy in Atrial Fibrillation in England: An Economic Analysis based on GRASP-AF Marion Kerr Insight Health Economics for NHS We would like to acknowledge PRIMIS who
More information