At least, in Canada this is usually the case. In that country, about 90% of patients who go to the hospital with AFib are discharged in the ER. In the United States, however, only about 20% go home, with the rest admitted into the hospital. And given that an estimated nearly 3 million people in the U.S. have the disease, that represents quite a burden on our healthcare system.
Dr. Anil Gehi, a cardiologist at the UNC School of Medicine in Chapel Hill, North Carolina, knew it didn’t have to be this way. “If the admission rate is so variable from country to country – and from hospital to hospital – you know there must be something wrong,” he said. Dr. Gehi committed himself to finding out what was wrong and doing what he could to fix it. He soon found significant support, in the form of a $1.7 million grant from the Bristol Myers Squibb Foundation, as part of its mission to promote health equity.
That’s how Dr. Gehi launched the AFib Care Network. The AFib Care Network has multiple approaches to improving AFib care in the community. Hospital ERs are paired with local cardiology AFib specialists so that appropriate patients can be discharged from the ER and set up with an expedited appointment. Primary care physicians, who are the major caregiver for a large number of AFib patients, are trained in best practices for AFib management. And patients are offered the opportunity to educate themselves about AFib to encourage them to get involved in their care and learn to self-manage the disease. Through the efforts, the program has led to a significant reduction in hospital admissions for atrial fibrillation within the UNC Health Care system. The impact has been felt the most among citizens of the state’s underserved communities, who have less access to specialists and are more likely to be treated exclusively by primary care physicians.
This translates into being more likely to head to the ER when it’s not necessary. As Dr. Gehi explained: “The AFib treatment guidelines are constantly evolving, and it’s very hard for a primary care physician to keep up. That leads to a lot of care variation. We knew that if we went directly to the primary care community and trained them, we could have a huge impact. So we ended up attacking this issue from two sides: from the patient side, with education and awareness, and from the care side, with streamlining and standardization.”