The Patient Pathway Review for Atrial Fibrillation

Abstract

The care pathway for patients with atrial fibrillation (AF) is variable and this variability is explored in a patient pathway review. This review describes events that may take place for a patient with AF considering the “ideal” and the “real-world” pathway and attempts to rationalize them by considering the patient, clinician, health service, and societal perspective. In the “ideal” pathway, AF in a patient is either identify before or after stroke. The “real-world” pathway introduces the concepts that symptoms may influence patient decision-making to seek help, AF may be identified incidentally, and healthcare professionals may fail to identify AF. The management of AF includes no treatment or treatment such as stroke prevention, rate or rhythm control, and comorbidity management. The overall outcomes for patient depend on the presence of symptoms and response to therapies. The two major priorities for patients are symptomatic relief and avoidance of stroke. While most clinicians will find that initial AF management is not challenging but there may be incidental opportunities for earlier identification. From the healthcare service perspective, noncardiologists and cardiologists care for patients with AF, which results in much heterogeneity management. From the societal perspective, the burden of AF is significant resulting in substantial cost from hospitalizations and treatments. People with AF can take on different paths, which depend on factors related to the patient’s decision-making, clinical decision-making, and patient’s response to the treatment. A streamlined approach to a holistic and integrated care pathway approach to AF management is needed.