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Include stroke prevention for members with Afib


Program for Afib patients could provide template of improved outcomes.

More forward-thinking organizations, however, are taking a broader view of what it takes to bring value to patients.

The American College of Physicians Foundation (ACPF) has undertaken an important initiative for a condition that most policymakers give little attention: atrial fibrillation (Afib), which is an irregular and often rapid heart rate that commonly causes poor blood flow to the body. In Afib, the chaotic rhythm could cause blood to pool in the heart's upper chambers and form clots, which could cause a stroke.

The ACPF, through an unrestricted educational grant from Jansen Pharmaceuticals, has completed Phase 1 of its Atrial Fibrillation and Stroke Prevention Initiative. While its primary focus is reducing stroke risk, the initiative took a broad view with the goal of optimal patient-centered care.

Quality gaps associated with Afib have led to poor health outcomes and burdens on the system. ACPF's initiative brought together key stakeholders to address these challenges and develop useful tools for patients, caregivers, clinicians and leaders of health systems.

Materials for patients and their caregivers included a guide and three videos designed to improve understanding of the condition and how to reduce stroke risk. For physicians, decision-support tools identify opportunities when blood thinners would reduce stroke risk.

The centerpiece of the initiative, however, was a 32-page guide for system-level leaders. The guide provides a comprehensive view of what would be needed to embed best-practice Afib care into a healthcare organization in a sustainable way. The case for putting Afib care on the quality agenda is clear. Given the high prevalence of Afib as a primary diagnosis and secondary comorbidity, improving the standard of care could reduce length of stay, stroke risk and readmission risk for multiple conditions-aligning incentives for patient, provider, healthcare system and payer.


The initiative's National Steering Committee included many important voices on the quality of Afib care including the American College of Cardiology, American Pharmacists Assn., and America's Health Insurance Plans, and provided oversight on the development of the materials. The ACPF's methodology emphasized listening to patient and clinician voices through multiple focus groups, leading to the creation of content that meets these stakeholders' specific needs in language that assures understanding.

Content for patients and providers is available for download at http://www.ACPFoundation.org/Afib/.

As healthcare reform continues to unfold in the United States, all participants in our healthcare system must meet the strict expectations set forth by the reform's sometimes narrow requirements, but we can and should also take a patient-centered approach to quality improvement.

Doron Schneider, MD, FACP is the chief patient safety and quality officer for Abington Health System.

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