Evidence based pathway for atrial fibrillation patients

Abstract

Atrial fibrillation is considered as the most common sustained arrhythmia and is increasing in prevalence in the aging population and considered as the main cause for stroke in patients aged over 75 years. In Lebanon as in many other countries, an increase in aging population is noted. In its latest statistical bulletin 2011, the Ministry of Public Health revealed that heart disease is the main cause for mortality and reason for hospital admission in Lebanon. A review of the medical records at AUBMC revealed an increase of the number of patients admitted with the diagnosis of atrial fibrillation from 2010 till 2012. Currently, no clinical pathway is available at the institution. The purpose of this project is the development of clinical pathway for patients with atrial fibrillation. Implementation and evaluation strategies were also developed.The three cornerstones in the management of atrial fibrillation include rate control, rhythm control and management of thromboembolism and stroke risks. Treatment includes medications, electrical therapy, and ablation procedures depending on the type and duration of the atrial arrhythmia. The proposed pathway is based on the American and European published guidelines for the management of patients with atrial fibrillation. The proposed pathway is divided into the three following components: initial assessment and diagnosis, treatment strategy and risk stratification and prevention of stroke. Along with the proposed pathway, an admission order form is developed to guide the practice upon admission. A multidisciplinary team is proposed to obtain consensus about the implementation phase and educational strategy for the staff to be adopted. A pre and post pathway implementation data will be collected through a proposed database to measure the quality of performance and patient outcomes.Clinical pathways are commonly used to ensure evidence-based practice and improve quality of patient care. In an area such as atrial fibrillation where research is continuously developing, formul