VIDEO: Gaps in the access to atrial fibrillation care


Interview with Dhanunjaya "DJ" Lakkireddy, MD, executive medical director for the Kansas City Heart Rhythm Institute at HCA Midwest Health, a professor of medicine at the University of Missouri, Columbia, and serves as deputy editor for the the Journal of Atrial Fibrillation, and serves on the Heart Rhythm Society Board of Trustees, section steering committee chair for the American College of Cardiology (ACC). He explains there is a big need to speed access to electrophysiologists (EPs) when a patient presents with atrial fibrillation (AFib).

"There are significant gaps in how a patient navigates the healthcare system for arrhythmia care," Lakkireddy explained. "It can be through an emergency room, urgent care or a primary care physicians office, the time it takes for the patient to jump through the hoops to get to an electrophysiologist takes way too long. And that is part of the reason why the outcomes are not as optimal as they should be." 

For AFib outcomes to improve, earlier interventions are needed before the disease progresses. So delays in care impact the patients, especially since many patients only present when they are have problematic symptoms at a later stage of AFib.

"When you look at this issue and cut out the inherent delay in the system and facilitate a patient's access to an electrophysiologist very quickly, we can minimize the amount of time to anti-coagulation therapy, anti-arrhythmic drugs, or top therapies like catheter ablation, this can in turn impact the morbidity and mortality the disease imposes on lapses of care," he explained 

Lakkireddy said this idea of fast-tracking EP care for AFib patients was tested in the Emergency Room to Electrophysiology (ER2EP) registry, which he presented as a late-breaking study at the Heart Rhythm Society (HRS) 2022 meeting. Read more about this study.

"What we found was very fascinating, a very simple intervention of changing the order from a patient presenting in the emergency room to either an inpatient electrophysiology service line or an out-patient electrophysiology office can dramatically cut out all the delays that you come across," Lakkireddy explained. "That translates into more meaningful, hard endpoints like reductions in heart failure readmissions, arrhythmia related readmissions, the number of transient ischemic strokes (TIAs) and strokes, and if we really followed these people out long enough, or in a larger cohort of patients, we even would have seen a mortality benefit too."  

He said this simple fast-tracking patients for more immediate EP care could greatly impact improve patient outcomes and help reduce healthcare costs.

"This is why it is important for moving these patients more quickly through these complex care pathways and getting them to the people who can help provide them with the proper care," Lakkireddy said. 

He also said the proliferation of consumer-grade and over the counter heart monitoring technology has caused more patients to seek help earlier, but this only impacts the tech savvy patients, and missed most of the older patients who largely do not use these devices. These devices also have created some issues in that patients often want to share their data with the physician, but if added to get these automated reports from the patient's Apple Watch, it can add up to hundreds of reports or pieces of data per month. And that was for just one patient.

"There really is no way in the world we can actually manage that kind of data deluge, and I see that as a major problem to implement that on a massive scale," Lakkireddy explained. 

While it is good patients are seeking help for potential AFib because of their wearable heart monitors, there is a need to streamline what to do with the large amounts of data these devices can generate. At this point, he said there is no feasible way to integrate all the patient's wearable data into patient records.

He also discusses the value of implantable cardiac monitors (ICMs) for long-term monitoring of patients to determine if they have an arrhythmia and what type to facilitate treatment. 

Dave Fornell is a digital editor with Cardiovascular Business and Radiology Business magazines. He has been covering healthcare for more than 16 years.

Dave Fornell is a healthcare journalist who has covered cardiology and radiology for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail:

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