A-fib patients at lower stroke, death risk with early cardiology care

Patients who receive cardiology care within 3 months of being diagnosed with atrial fibrillation may be at much lower risk of stroke and premature death, compared with patients who receive primary care, a new study finds.

Senior study author Dr. Mintu Turakhia, of the Center for Digital Health at Stanford University Medical Center in California, and colleagues recently published their findings in the Journal of the American College of Cardiology.

Atrial fibrillation (A-fib) is a condition characterized by the irregular beating of the heart's upper chambers, which can cause blood clots and reduced blood flow.

According to the American Heart Association, A-fib affects at least 2.7 million people in the United States, and the condition is a major risk factor for stroke, heart failure, and other heart-related conditions.

Treatments for A-fib include lifestyle changes, medications (such as anti-coagulants and beta-blockers), and medical procedures (such as catheter ablation).

Dr. Turakhia and colleagues note that all of these treatments vary in complexity and risk, and that the type of treatment a patient receives may differ by care setting.

For their study, the researchers set out to gain a better understanding of how treatments and outcomes might vary among patients with A-fib, depending on whether they are treated by a general practitioner (GP) or a cardiologist.

Better outcomes with cardiology care

The team analyzed data from the U.S. Department of Veterans Affairs healthcare system, identifying 184,161 adults who were diagnosed with A-fib between 2004 and 2012.

Around 40 percent of patients received care from a cardiologist within 90 days of diagnosis, while the remaining 60 percent received care from a GP, with no referral to a cardiologist.

Compared with GP-treated patients, those who were treated by a cardiologist within 90 days of diagnosis were found to have a 9 percent lower risk of stroke and an 11 percent lower risk of death.

A-fib patients treated by a cardiologist were more likely to be prescribed anti-coagulant medications, the team reports, which appeared to explain the lower stroke risk.

"To start, the patients who received cardiology care were also a whole lot sicker at baseline, so you'd expect their outcomes to be worse. In fact, we saw the opposite," says Dr. Turakhia.

"The important message here is that getting early cardiology care was associated with early prescription of drugs specifically for preventing stroke. These findings show that it is important to think of these interventions at the time of diagnosis."

Dr. Mintu Turakhia

The findings remained even after accounting for a wealth of possible confounding factors, such as age, insurance coverage, the presence of other medical conditions, and the use of other medications.

'We need to fill the gaps in care'

Additionally, the researchers found that A-fib patients who were treated by a cardiologist within 90 days of diagnosis were more likely to be hospitalized.

However, the team says that this is not necessarily a negative finding, noting that these patients may have experienced better outcomes because they were hospitalized.

The analysis revealed that the majority of patients resided in rural areas, meaning that they had further to travel in order to visit a cardiologist, who are primarily based in urban settings.

"That makes the case that proximity may be a big factor in access to care," says Dr. Turakhia. "One of the solutions may be virtual visits or similar options."

Since the study is solely observational, the researchers are unable to conclude that cardiology care is always better than primary care for patents with A-fib.

"We're not saying that we just need to clone more cardiologists - that is exactly the wrong solution," says Dr. Turakhia. "Rather, this research indicates that we need to fill gaps in care and find smarter ways to deliver it so it doesn't matter who a patient sees or how far away they live."

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