Implementing Systematic Screening Driven by Quality Improvement Education (QIE) for Atrial Fibrillation during the Covid-19 Pandemic: Insight from Primary Care Setting in the United States

ABSTRACT

Background: Asymptomatic patients with atrial fibrillation (AF) pose challenges to diagnosis. Early diagnosis can reduce morbidity and mortality. Systematic screening in primary care may result in early intervention. Objectives: We sought to examine the implementation outcomes of a systematic, team-based quality improvement education (QIE) intervention for AF screening in primary care during the COVID-19 pandemic. Methods: QIE intervention was implemented in academic-based (n=4) and community-based (n=2) practices to address COVID-19 challenges. Surveys administered by site identified existing approaches and provider teams developed screening protocol based on targeted education, deploying a mobile ECG device (Kardiamobile™). Patient charts were reviewed (Dec 2020-May 2021) to determine eligibility, i.e., patients aged 65-74 (with prior stroke/TIA or two other risk factors) or aged ≥75 (with one other risk factor) without prior AF. Patient EHR data were examined for demographic/clinical data and screening outcome. Provider interviews (n=12) and validation from representative patients (n=2) accounted for sustainability of outcomes. Results: A total of 1,221 patients were evaluated for AF risk, with 408 eligible for screening. Of these, 277 (68%) were female and CHA2DS2-VASc varied-score=3 (45%);score=4 (24%);score=5+ (31%). Patients (n=7;2%) who screened positive for AF were referred or started on anticoagulation, like other primary care studies. Figure 1 shows how systematic screening was re-imagined and implemented Satisfaction and engagement increased among providers and patients-attributed, in part, to benefits of team-based planning and targeted education. Conclusion: An AF screening program was adapted to improve patient care despite COVID-19 related challenges. A QIE toolkit was launched to assist primary care practices with implementing streamlined, sustainable, and patient-engaging strategies to reduce stroke.