Date of Award

2019-05-10

Degree Name

PhD Nursing

Dissertation Committee

Joseph F. Burkard, DNSc, CRNA, Chairperson; Jonathan Mack, PhD, RN, NP; Mehran Moussavian, DO, FACC

Keywords

ANTICOAGULATION THERAPY, CARDIOLOGY, ATRIAL FIBRILLATION, IMPLANTABLE CARDIAC MONITOR

Abstract

The purpose of this research was to (a) examine the demographics of patients receiving care in an outpatient cardiology clinic, (b) describe the relationship between the atrial fibrillation (AF) and other variables (e.g., BMI), (c) examine the frequency and the length of time to AF diagnosis in patients implanted with an implantable cardiac monitoring (ICM) device, (d) observe provider patterns of treatment with oral anticoagulants (OACs), and (e) investigate documented considerations to either diagnose or rule out OSA in a group of outpatient AF patients in a cardiology clinic.

Background: AF is largely undiagnosed but can cause major morbidity and mortality. AF is the most prevalent sustained arrhythmia encountered in the emergency department, is frequently detected in those without a prior diagnosis of AF, and is the most common cause for stroke. All relevant guidelines suggest patients from intermediate to high risk for stroke should receive OAC; however, this therapy is prescribed in less than 55% of eligible patients. AF accounts for nearly 1 in 7 strokes and affects approximately 5.8 million people in the United States.

Objectives: The purpose of this study is to identify and intervene in patients with atrial fibrillation using an implantable cardiac monitor to significantly improve guideline-based anticoagulation therapy.

Methods: A retrospective database from an outpatient clinic in southern California was analyzed in this non-experimental study design; it comprised routinely-collected data on patients with ICMs implanted between June 1, 2014 and December 31, 2018. This study was designed to establish the incidence of AF using an ICM device (i.e., Medtronic LINQ) in the outpatient setting.

Conclusions: As evidenced by this study, most patients would not have been diagnosed with AF utilizing the shorter-duration monitoring devices typically used as the first line of treatment. Longer monitoring capabilities promise early identification of disease and reduction in morbidity for AF patients.

Discussion: The incidence of AF using an ICM (i.e., Medtronic LINQ) device in an outpatient clinic was 23.4% (63 out of 269 patients), similar to national studies stating that longer monitoring of cardiac rhythms increased the diagnosis of arrythmias. Only 12.7% of detected AFs (11 out of 63 patients) occurred before 14 days, the maximum time available through the use of other, traditional monitoring devices in standard use; therefore, an alarming 87.3% of ICM-detected arrythmias could have remained unidentified. This research observed a reduction of potential, highly-debilitating embolic stroke through detection as well as a lessened risk of all-cause mortality with OACs for AF patients without stroke prophylaxis; early identification and treatment is possible utilizing an ICM device.

Document Type

Dissertation: Open Access

Department

Nursing

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