A bridge to a cardiologist for AFib patients diagnosed in the ER

Atrial fibrillation patients now have support through a new Cape Cod Healthcare initiative that fills the gap between the emergency room and the cardiologist’s office.

AFib is an abnormal rhythm, or arrhythmia, in the upper chambers of the heart. It can result in a rapid, disorganized and inefficient beat that keeps the blood from flowing through the heart, creating a greater risk of blood clots and stroke. Risk factors for AFib include age, moderate to heavy alcohol use, smoking, hyperthyroidism, and chronic conditions such as obesity, diabetes, kidney disease, heart failure, sleep apnea and high blood pressure, according to the U.S. Centers for Disease Control and Prevention.

And AFib can create uncomfortable and sometimes frightening symptoms, such as rapid heartbeat or lightheadedness, said Adam Mohmand-Borkowski, MD, PhD, FHRS, a cardiac electrophysiologist with Cape Cod Healthcare’s Cardiovascular Center in Hyannis.

“Overall, atrial fibrillation is usually not a life threatening condition, but it can be very symptomatic,” he said. “Although some patients are relatively asymptomatic, most people have an associated rapid pulse with atrial fibrillation and they may feel palpitations. They may feel shortness of breath with physical activity. They may feel tired.”

And those symptoms often send people to the emergency room. In fact, AFib is one of most common cardiac diagnoses in ER as at age 40, lifetime risk of developing atrial fibrillation is approximately 25% Dr. Mohmand-Borkowski said. When a patient does show up in the ER, doctors treat the immediate symptoms with blood thinners to prevent clots leading to stroke, and medication to slow the heart rate. Patients are then told to see a cardiologist for long-term management.

A New Connection

That’s when things can get bumpy. Patients may have recurrent symptoms before seeing a cardiologist or have just lost the follow up. But now, post-ER patients are connected to a nurse practitioner at the CCH Cardiovascular Center who is an expert on treatment strategies and helps them navigate the initial process of getting care. This AFib clinic is a middle step that connects acute and long-term care, and makes it more likely patients will receive follow-up care from a cardiologist, Dr. Mohmand-Borkowski said. And, it reduces the likelihood that patients will need to return to the ER for treatment during the gap between ER and follow-up, he said.

“We wanted to create some form of a bridge between diagnosis and the patient being able to be seen by a cardiologist,” he said. “We want to make sure those patients are educated early about the disease, have a care plan in place, and that they are medically stable while they wait to be seen by a cardiologist.”

Under the new system, AFib patients meet in person with nurse practitioner Kimberly Odell after they are discharged from the ER.

“She makes sure that everything which was recommended in the ER is in place, that the patient is stable on the treatment regimen, and that the patient has a follow-up with a cardiologist in place,” Dr. Mohmand-Borkowski said. “And she discusses with them interventions the patient can do, possibly referring them to our dietician program, our wellness program to increase physical activity, or to the sleep center for a sleep study. And she discusses patient options of therapy so the patient becomes the partner to their cardiologist.”

Odell becomes the main contact for patients while their treatment is being organized. And she follows up in a few weeks to make sure the patient has a plan in place and is working with a cardiologist.

Treatment Options

There are ways to treat AFib so it doesn’t interfere with normal life, Dr. Mohmand-Borkowski said. Options include blood thinners to protect patients from stroke; medications to control heart rate and rhythm, cardioversion which uses electricity to acutely shock the heart back into normal rhythm; and ablation procedure, which serves to place the patient back into the normal rhythm long term. Doctors may also implant devices such as the Watchman, which, by closing off a small pocket area of the heart called the left atrial appendage, prevents clot formation and allows stopping blood thinning medications.

Cardiologists also recommend lifestyle changes, such as losing weight, regular physical activity, getting treatment for sleep apnea and cutting back on alcohol, he said.

“This is a disease that can be very disturbing,” Dr. Mohmand-Borkowski said. “But if it’s appropriately treated, you can have long periods of remission of the disease and not lose your quality of life.”