{
  "abstract": "Introduction The 2024 European Society of Cardiology (ESC) AF guidelines introduce new pillars for AF management, emphasizing the development of approaches and models for integrated, shared care that aim to reduce health inequalities.Background In Coventry and Warwickshire, a community nurse-led AF clinic was piloted to redesign the regional AF pathway and access to care, following ESC recommendations, whilst reducing the local healthcare burden. Located in the most deprived area, it accepts referrals from primary and secondary care. The clinic, staffed by two arrhythmia nurses, offers same-day echocardiography and is overseen by an Electrophysiology Consultant. This integrates community-based care with specialist secondary services.AF management follows the ESC AF-CARE pillars: [C] Comorbidity and risk factor management; [A] Stroke and thromboembolism prevention with anticoagulation; [R] Symptom reduction through rate and rhythm control; and [E] Evaluation with ongoing reassessment. Patients are directly listed for cardioversion or AF ablation when appropriate. This pathway is being nationally recognized as a NHS England Blueprint and is part of the Stroke Association’s 10-year plan.Results Between November 1st, 2024, and August 1st, 2025, the nursing team saw 568 new patients, with 428 requiring a same-day echocardiogram (GIRFT table 1). Referrals came from across the region: Coventry 60.2%, Rugby 19.1%, Nuneaton and surrounding areas 15.6%, and South Warwickshire 5.1%. All patients received risk factor management, lifestyle advice, and stroke risk assessment. Regarding AF management decisions: 1) 553 patients were anticoagulated, 2) 167 were directly listed for cardioversion, 3) 102 were referred directly for AF ablation, and 4) 299 received medical treatment. The AF healthcare burden was reduced through: 1) 24.1% (n=137) avoided A&E attendances due to elevated heart rates (>100 bpm), 2) 14.1% (n=80) avoided hospital admissions through direct A&E referrals, and 3) waiting times for initial specialist input decreased from an average of 15.34 weeks (SD ± 4.5) to 5.1 weeks. Additionally, same-day echocardiography identified early heart failure in 23.6% (n=134) of cases, leading to timely treatment initiation.Data collection is ongoing. In Coventry and Warwickshire, there are approximately 1,400 strokes annually, with 345 (25%) occurring in patients with known AF. Currently, only 61.8% of these AF patients are anticoagulated before their stroke, compared to a national average of 72.7%. If the remaining 38.2% of AF patients were appropriately anticoagulated prior to their stroke, the relative risk reduction would be 70%, leading to a 26.7% overall decrease in AF-related strokes annually. This could prevent approximately 92 strokes each year in our region. The estimated hospital costs for an acute stroke admission range from £10,000 to £20,000 per patient, translating to potential savings of between £920,000 and £1,840,000 annually.Conclusion The pilot clinic 9-month preliminary data suggest the clinic has significantly reduced the local AF healthcare burden and improved AF care. The clinic could be a key example of a clinically effective model in keeping with the ESC 2024 guidanceAbstract 361 Table 1GIRFT – Getting it Right First Time for AF careMeasureDeliverablesOutputs (10/24 – 1/08/20)BenefitWaiting timesRTT Reduction for 1st Arrhythmologist specialist inputReduced by 15.34 weeksEarly specialist input improves AF outcomes Reduction in general cardiology outpatient RTT through redirection of AF referrals to community clinicRe-directs from arrhythmia clinics 108Improved RTT for general and specialist cardiology appointmentsMultiple outpatient visitsSame day echocardiography avoiding additional hospital attendanceTotal 428Earlier echo for general cardiology New detection of heart failure & initiation of anti-heart failure medication23.5% new heart failure detected(46 mild, 50 moderate, 38 severe)Improved heart function with earlier initiation of therapies Pre-op appointments as pre-op for cardioversion & AF ablation completed in clinic.Total requiring pre-op 241(cardioversion 167, AF ablation 102)Improved catheter lab utilisation with pre-op completed.Regional Healthcare costsReduction in AF burdenHospital AF healthcare costA&E attendance avoidances137 A&E attendance avoidancesReduction in A&E waiting times. Hospital admission avoidances80 A&E referrals to AF clinic Reduced length of stay with discharge for community clinic FU71 inpatient discharge referralsRegional Stroke Relative RiskAF related stroke are often more disabling and costly strokes.Appropriate AF stroke prevention medication reduces AF related stroke by 70%. Initiation of stroke prevention medication and complex medication initiation decisionsTotal 243Estimated 170 strokes saved in the long-term",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Coventry & Warwickshire, Coventry, United Kingdom"
      ],
      "name": "Sheila Wood"
    },
    {
      "affiliations": [
        "University Hospitals Coventry & Warwickshire, Coventry, United Kingdom"
      ],
      "name": "Navdeep Singh"
    },
    {
      "affiliations": [
        "University Hospitals Coventry & Warwickshire, Coventry, United Kingdom"
      ],
      "name": "Kuldip Kullar"
    },
    {
      "affiliations": [
        "University Hospitals Coventry & Warwickshire, Coventry, United Kingdom"
      ],
      "name": "Claire Brooker"
    },
    {
      "affiliations": [
        "University Hospitals Coventry & Warwickshire, Coventry, United Kingdom"
      ],
      "name": "Sara Santos"
    },
    {
      "affiliations": [
        "University Hospitals Coventry & Warwickshire, Coventry, United Kingdom"
      ],
      "name": "Lisa Fereday"
    },
    {
      "affiliations": [
        "Coventry & Warwickshire Primary Care Trust, Coventry, United Kingdom"
      ],
      "name": "Sarah Geissler"
    },
    {
      "affiliations": [
        "Institute of CardioMetabolic Research, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom"
      ],
      "name": "Ven Gee Lim"
    },
    {
      "affiliations": [
        "Institute of CardioMetabolic Research, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom",
        "University of Warwick, Coventry, United Kingdom"
      ],
      "name": "Faizel Osman"
    },
    {
      "affiliations": [
        "Institute of CardioMetabolic Research, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom",
        "University of Warwick, Coventry, United Kingdom"
      ],
      "name": "Helen Eftekhari"
    },
    {
      "affiliations": [
        "Institute of CardioMetabolic Research, University Hospitals Coventry & Warwickshire, Coventry, United Kingdom"
      ],
      "name": "Sandeep Panikker"
    }
  ],
  "title": "361 An innovative strategy and national framework for atrial fibrillation care integration: early insights from a nine-month pilot of a nurse-led community clinic in Coventry and Warwickshire to reduce the local burden",
  "uid": "b815f9af-1ec5-5249-a994-51076b712b72"
}