Authors (including presenting author) :
Lai KPL, Chan PF, Fung HT, Wong SN, Luk MHM, Chan WY, Wong KP, Tsang LF
Affiliation :
Department of Family Medicine and Primary Health Care, Kowloon East Cluster (KEC)
Introduction :
Atrial fibrillation (AF) is one of the commonest cardiac arrhythmias which increases the stroke risk by 5-fold. With the aging population, more patients were diagnosed with AF in primary care. To meet the service demand, AF clinics (AFC) were set up at KEC GOPCs since 2019 with non-vitamin K oral anticoagulants (NOACs) introduced. As echocardiography is essential to AF assessment, transthoracic echocardiography (TTE) service was also implemented in our AFC since 2023. Most patients with stable and symptom controlled AF could therefore be comprehensively managed in primary care.
Objectives :
To provide a one-stop service for patients with AF in primary care so as to reduce referral to secondary care.
Methodology :
Updated clinical guidelines were prepared to guide the pharmacological treatment of AF and its complications. TTE training for family medicine consultants were provided by parent hospitals’ cardiologists. TTE service was implemented in GOPCs since December 2023. GOPC patients with newly diagnosed AF or known AF requiring further assessment would be referred to AFC. Patients without baseline echocardiography or with valvular problems requiring follow up assessment would be arranged with TTE.
To evaluate the outcomes of patients attending AFC after the implementation of the one-stop service, clinical information of all patients attending the clinics from 1st December 2023 to 30th November 2024 were reviewed.
Result & Outcome :
426 patients attended the AFC during the review period. 52.1% were male patients and the mean age was 77.6 (range 47-98) years old. The mean duration of AF was 4.1 years. 19.2% and 5.4% of patients had history of cerebrovascular disease and heart failure respectively.
Among the patients indicated for NOACs, 81.6% (341/418) agreed to take the drug in which 40.2% were initiated in AFC. Only 1 patient (0.3%) developed major side effect of NOAC with intracranial haemorrhage.
151 (35.4%) TTE were arranged with 108 TTE performed. 81.5% (88/108) of patients had various degrees of valvular heart diseases in which 2 patients had mitral stenosis while 2 patients had aortic stenosis. 7.4% of patients had reduced left ventricular ejection fraction. 1 patient was suspected having ventricular septal defect.
8.5% (36/426) of patients were referred to cardiologists. The reasons for referral included significant abnormal echocardiographic findings (52.8%), persistent AF related symptoms (16.7%) and heart failure (13.9%).
Conclusion:
With the implementation of the one-stop service, AF patients could receive timely, convenient and comprehensive assessment and management in primary care and also reduce the referral to secondary care.
