Implementation of a screening and management pathway for chronic obstructive pulmonary disease in patients with atrial fibrillation
Research output: Contribution to journal › Journal article › Research › peer-review
Standard
Implementation of a screening and management pathway for chronic obstructive pulmonary disease in patients with atrial fibrillation. / van der Velden, Rachel M J; Hereijgers, Maartje J M; Arman, Nazia; van Middendorp, Naomi; Franssen, Frits M E; Gawalko, Monika; Verhaert, Dominique V M; Habibi, Zarina; Vernooy, Kevin; Koltowski, Lukasz; Hendriks, Jeroen M; Heidbuchel, Hein; Desteghe, Lien; Simons, Sami O; Linz, Dominik.
In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Vol. 25, No. 7, euad193, 04.07.2023, p. 1-10.Research output: Contribution to journal › Journal article › Research › peer-review
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Implementation of a screening and management pathway for chronic obstructive pulmonary disease in patients with atrial fibrillation
AU - van der Velden, Rachel M J
AU - Hereijgers, Maartje J M
AU - Arman, Nazia
AU - van Middendorp, Naomi
AU - Franssen, Frits M E
AU - Gawalko, Monika
AU - Verhaert, Dominique V M
AU - Habibi, Zarina
AU - Vernooy, Kevin
AU - Koltowski, Lukasz
AU - Hendriks, Jeroen M
AU - Heidbuchel, Hein
AU - Desteghe, Lien
AU - Simons, Sami O
AU - Linz, Dominik
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2023/7/4
Y1 - 2023/7/4
N2 - AIMS: Chronic obstructive pulmonary disease (COPD) negatively impacts the efficacy of heart rhythm control treatments in patients with atrial fibrillation (AF). Although COPD is recognized as a risk factor for AF, practical guidance about how and when to screen for COPD is not available. Herein, we describe the implementation of an integrated screening and management pathway for COPD into the existing pre-ablation work-up in an AF outpatient clinic infrastructure.METHODS AND RESULTS: Consecutive unselected patients accepted for AF catheter ablation in the Maastricht University Medical Center+ were prospectively screened for airflow limitation using handheld (micro)spirometry at the pre-ablation outpatient clinic supervised by an AF nurse. Patients with results suggestive of airflow limitation were offered referral to the pulmonologist. Handheld (micro)spirometry was performed in 232 AF patients, which provided interpretable results in 206 (88.8%) patients. Airflow limitation was observed in 47 patients (20.3%). Out of these 47 patients, 29 (62%) opted for referral to the pulmonologist. The primary reason for non-referral was low perceived symptom burden. Using this screening strategy 17 (out of 232; 7.3%) ultimately received a diagnosis of chronic respiratory disease, either COPD or asthma.CONCLUSION: A COPD care pathway can successfully be embedded in an existing AF outpatient clinic infrastructure, using (micro)spirometry and remote analysis of results. Although one out of five patients had results suggestive of an underlying chronic respiratory disease, only 62% of these patients opted for a referral. Pre-selection of patients as well as patient education might increase the diagnostic yield and requires further research.
AB - AIMS: Chronic obstructive pulmonary disease (COPD) negatively impacts the efficacy of heart rhythm control treatments in patients with atrial fibrillation (AF). Although COPD is recognized as a risk factor for AF, practical guidance about how and when to screen for COPD is not available. Herein, we describe the implementation of an integrated screening and management pathway for COPD into the existing pre-ablation work-up in an AF outpatient clinic infrastructure.METHODS AND RESULTS: Consecutive unselected patients accepted for AF catheter ablation in the Maastricht University Medical Center+ were prospectively screened for airflow limitation using handheld (micro)spirometry at the pre-ablation outpatient clinic supervised by an AF nurse. Patients with results suggestive of airflow limitation were offered referral to the pulmonologist. Handheld (micro)spirometry was performed in 232 AF patients, which provided interpretable results in 206 (88.8%) patients. Airflow limitation was observed in 47 patients (20.3%). Out of these 47 patients, 29 (62%) opted for referral to the pulmonologist. The primary reason for non-referral was low perceived symptom burden. Using this screening strategy 17 (out of 232; 7.3%) ultimately received a diagnosis of chronic respiratory disease, either COPD or asthma.CONCLUSION: A COPD care pathway can successfully be embedded in an existing AF outpatient clinic infrastructure, using (micro)spirometry and remote analysis of results. Although one out of five patients had results suggestive of an underlying chronic respiratory disease, only 62% of these patients opted for a referral. Pre-selection of patients as well as patient education might increase the diagnostic yield and requires further research.
KW - Humans
KW - Atrial Fibrillation
KW - Pulmonary Disease, Chronic Obstructive/complications
KW - Lung
KW - Risk Factors
U2 - 10.1093/europace/euad193
DO - 10.1093/europace/euad193
M3 - Journal article
C2 - 37421318
VL - 25
SP - 1
EP - 10
JO - Europace
JF - Europace
SN - 1099-5129
IS - 7
M1 - euad193
ER -
ID: 370572289