Patient Care Pathways and Outcomes Following Newly Diagnosed Atrial Fibrillation

Clinical Snapshot

Key Findings

• P Value: Statistically significant (p<0.05 implied by CI not crossing 1.0)

• Effect Size: Stroke risk reduction HR 0.63 in patients ≥80 years with electrophysiologist care

• Primary Outcome: 20.6% of patients had electrophysiologist consultation within 1 year

• Nnt Or Sensitivity: 37% relative risk reduction for stroke in elderly patients with electrophysiologist care

• Confidence Interval: 95% CI 0.42-0.95

Clinical Application

Requires adequate electrophysiology services and referral pathways - may be challenging in rural/remote areas Relevant to Australian practice - electrophysiology services available through public/private systems, PBS covers relevant medications, aligns with NHFA/CSANZ AF guidelines Adults with newly diagnosed atrial fibrillation, particularly elderly patients at high stroke risk

Abstract

BACKGROUND: Care pathways for patients with atrial fibrillation (AF) are poorly understood and may influence the likelihood of guideline concordant oral anticoagulation or antiarrhythmic drug therapy and associated outcomes. METHODS: Adult patients in the Optum Clinformatics Database (2015-2023) with incident AF were identified. Care pathways, by treating clinician specialty (primary care, cardiology, electrophysiology) during each AF-related visit in the 1 year post diagnosis were examined. Cox regression models were used to assess associations between an electrophysiologist visit and AF-related treatments including antiarrhythmic drug therapy and oral anticoagulation and outcomes including AF-related hospitalizations, heart failure hospitalizations, and stroke. RESULTS: Of the 37 370 patients included, 7700 (20.6%) had a care pathway including an electrophysiologist visit. Older patients (70-79 and 80+ versus 18-49 years: hazard ratio [HR], 0.71 [95% CI, 0.64-0.78] and HR, 0.57 [95% CI, 0.51-0.63], respectively) and those with a higher CHA2DS2-VASc score (2-3 and ≥4 versus 0-1: HR, 0.79 [95% CI, 0.74-0.85] and HR, 0.76 [95% CI, 0.68-0.84], respectively) were less likely to have an electrophysiologist visit. Electrophysiologist visits were associated with a significant increase in rates of treatment with antiarrhythmic drug and oral anticoagulation. Patients aged ≥80 years with an electrophysiologist visit had significantly lower risks of stroke compared with those without an electrophysiologist visit (HR, 0.63 [95% CI, 0.42-0.95]). CONCLUSIONS: Certain demographic groups including older patients had lesser likelihood of electrophysiologist consultation, but guideline concordant care was more likely associated with electrophysiology care pathways. Electrophysiology care pathways were associated with improved outcomes especially among the groups with greatest stroke risk.

References

1. 1.Zeitler, E. P., Jackson, L. R., Natale, A., Piccini, J. P., Pokorney, S. D., Russo, A. M., Sandhu, R. K., Khanna, R., Iglesias, M., Rong, Y., & Bunch, T. J. (2026). Patient care pathways and outcomes following newly diagnosed atrial fibrillation. Journal of the American Heart Association, Article 046111. https://doi.org/10.1161/JAHA.125.046111