Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Ka Man LAU (1), To Fung LEUNG (2), Yim Chu LI (1), Catherine Xiao Rui CHEN (1)
Affiliation :
(1) Department of Family Medicine and General Out-patient Clinics, Kowloon Central Cluster of the Hospital Authority of Hong Kong.
(2) Box Hill Superclinic, 810 Whitehorse Road, Box Hill VIC 3128, Australia
Introduction :
Atrial fibrillation (AF) is a common type of arrhythmia encountered in primary care and is a cause of significant morbidity and mortality. Patients with AF have five-fold increased risk of stroke compared with non-AF patients, and the use of oral anticoagulation (OAC) significantly reduced the risk of stroke in AF patients. Therefore, OACs are an integral part of AF management to prevent the thromboembolic events. Strict control of cardiovascular disease (CVD) risk factors is also an essential part of AF management.comprehensive management to AF patients in the community. This study tried to explore the clinical effectiveness of AFSC by evaluating its impact on OAC use and the control of CVD risk factors among high risk AF patents managed by primary care physicians. We believe that AFSC would help enhance OAC utilization and improve CVD risk factor control, and hence reducing AF related mortality in the long run.
Objectives :
Service gaps exist in oral anticoagulant (OAC) use among patients with atrial fibrillation (AF) in primary care. The purpose of this study was to explore the clinical effectiveness of a community dwelling Atrial Fibrillation Special Clinic (AFSC) run by primary care physicians by evaluating its impact on OAC use and the control of modifiable cardiovascular disease (CVD) risk factors in high risk AF patients.
Methodology :
Quasi-experimental study was conducted in AFSC run by public primary care physicians in Hong Kong. Study subjects were high risk AF patients with CHA2DS2-VASc scores ≥2, who had been followed up (FU) at AFSC for at least one year from 01 August, 2019 to 31 October, 2020. OAC usage and modifiable CVD risk factor control were compared before and after one year of FU at AFSC. Drug-related adverse events, emergency attendance or hospitalisation episodes, survival and mortality rates after one year FU at AFSC were also reviewed.
Result & Outcome :
AFSC is effective in enhancing OAC use and maintaining optimal modifiable CVD risk factor control among high risk AF patients managed in primary care setting, and therefore may reduce AF-associated morbidity and mortality in the long run. Among the 299 high risk AF patients included in the study, significant increase in OAC use was observed from 58.5% at baseline to 82.6% after one year FU in AFSC (P <0.001). Concerning CVD risk factor control, the average diastolic blood pressure level was significantly reduced (P=0.009) and the satisfactory blood pressure control rate in non-diabetic patients was markedly improved after one year FU (P=0.049). However, the average HbA1c and LDL-c levels remained static. The annual incidence rate of ischaemic stroke/systemic embolism was 0.4%, intra-cranial haemorrhage was 0.4%, major bleeding episode was 3.2% and all-cause mortality was 4.3%, all of which were comparable to reports in the literature.
