Q & A: Evaluation and Management of the Atrial Fibrillation Patient

In this feature interview, the Society of Cardiovascular Patient Care speaks with Benjamin A. Steinberg, MD about their upcoming White Paper entitled “Evaluation and Management of the Atrial Fibrillation Patient: A Report from the Society of Cardiovascular Patient Care.” Dr. Steinberg is from the Division of Cardiovascular Medicine and Department of Medicine at Duke University Medical Center and Duke Clinical Research Institute.

Atrial fibrillation (AF) is often overlooked or given secondary consideration behind chest pain and heart failure, but recently it appears to be gaining traction. Why is that? 

Steinberg: You’re right — AF has been gaining increased awareness. This is probably multi-factorial. With many more patients receiving implantable devices or longer-term heart rhythm monitoring, we’re likely diagnosing more patients than we used to. More importantly, the number of patients at risk for AF is increasing — the population is aging, and the prevalence of AF increases with age. We’ve also experienced great successes in the treatment of patients with heart failure and/or coronary artery disease, both common forms of structural heart disease, which is another major risk factor for AF. Lastly, therapies for AF are greatly improving and doing so very rapidly — these include novel approaches to stroke prevention and safer, more effective catheter-based approaches. The end result of all these factors is heightened awareness of AF! 

The White Paper mentions that AF “will increase 2.5-fold in the next 40 years to 5 million adults.” Is the industry ready for that kind of epidemic?

Steinberg: Well, that’s what the White Paper is all about — reaching out to the providers on the front lines, to help introduce a framework for how to think about and manage these patients. One of the challenges is that AF can manifest in a variety of settings, from the emergency department and primary care clinics, to neurologists’ and vascular disease specialists’ offices. Our goal is to help educate healthcare workers about how to provide the best care for patients with AF.

Talk about the framework ... it sounds ambitious.

Steinberg:  Well, the White Paper was in part designed to help healthcare facilities implement guideline-based care for the patient with AF. We have a significant amount of evidence on how to treat many of these patients — the guidelines summarize these data and make recommendations. However, implementing such recommendations, and realizing the benefits of that process in the form of improved clinical outcomes, remains a challenge for many providers and healthcare facilities. Therefore, to the extent that we can demonstrate how to implement good clinical care through an efficient system in everyday practice, that is the goal.

Does the White Paper illustrate “how to” implement good clinical care?

Steinberg:  I think it helps guide clinicians on how to interpret the guidelines, as well as provides examples where standardized and/or structured protocols are useful. We also try to highlight all of the necessary components to a strong clinical program, such as involvement of administrators, nursing and support staff, emergency medical services, and the community.

What kind of team was assembled to interpret the guidelines and gather the examples?

Steinberg:  We were fortunate to work with a broad complement of thought leaders from around the country. You’ll notice the author block includes a variety of institution affiliations, with subspecialists such as electrophysiologists, specialists in gastroenterology, hematology, and cardiothoracic surgery, as well as cardiologists, emergency medicine providers, and nursing. We also had input from hospital administrators. This provided unique perspectives, as well as input from as many interested parties as possible.

Did you get the sense from the group that AF awareness was building, and that the idea that it’s a growing epidemic was finally gaining attention?

Steinberg: I think we all acknowledge the coming challenges of more patients who are more complex, receiving new therapies, in the broader setting of a changing healthcare landscape.

For more information, please visit the Society of Cardiovascular Patient Care