Standardizing Evidence-Based Care for Atrial Fibrillation Using Clinical Pathways - A Practical Approach

Abstract

While atrial fibrillation remains the most common cardiac arrhythmia and cause of stroke, management of atrial fibrillation varies widely from institution to institution and from provider to provider despite the existence of widely-published, multi-society guidelines. Initial diagnostic workup, first-line anticoagulant choice, rate- vs. rhythm-control approaches, and timing of referral for ablation or left atrial appendage closure devices vary. Standardization of these and other care processes leads to more reproducible outcomes and overall improvement in patients’ symptoms and quality of life. However, distilling this large volume of available evidence and guidelines into practical care algorithms which providers can use to guide care in the real world can be a daunting task. In this chapter, we will discuss the practical approach to building a clinical pathway for the management of atrial fibrillation in the Inpatient and Emergency Department settings including our approach to weighing available evidence, building provider consensus, designing and refining the pathway, initial pathway launch, sustaining the change, measuring success, and updating the pathway as new evidence emerges. This chapter will draw heavily from our 10 years of experience building clinical pathways at the University of Chicago with special focus on generalizable points that can be applied to readers’ home institutions.