In his Department of Internal Medicine Grand Rounds lecture, “Contemporary Advances in the Management of Atrial Fibrillation,” Associate Professor of Medicine in Cardiac Electrophysiology, James Freeman, MD, the director of the Yale Atrial Fibrillation Program, shared that modern treatments have markedly improved our ability to prevent AF-related morbidity and mortality. AF is the most common heart arrhythmia that puts between 3-6 million Americans at risk for stroke and death and causes substantial symptoms that significantly worsen quality of life.
As Americans age and increasingly have risk factors for AF including obesity, hypertension, and diabetes, medical costs and hospitalizations due to AF are rapidly increasing. The Yale Atrial Fibrillation Program has undertaken several efforts to standardize care and improve outcomes for AF patients across the Yale New Haven Health System.
Anticoagulants such as warfarin and the direct oral anticoagulants (DOACs) are blood thinners that reduce by 60-70% the risk of blood clots forming in the heart and circulating to the brain resulting in an ischemic stroke. Warfarin has been the mainstay of therapy for over 30 years, but in the wake of recent clinical trials the DOACs are increasingly first-line treatment for stroke prevention.
Despite the effectiveness of blood thinners, many patients can’t tolerate these medications, most commonly due to bleeding events. For these patients, Freeman recommends left atrial appendage occlusion (LAAO), which can prevent blood clots from forming in the heart and causing stroke without the need for long term blood thinners. The most commonly used device currently is the WATCHMAN device (Boston Scientific), and several other devices are in various stages of development and study. Freeman is leading an Integrated Care Model (ICM) project to identify patients through the electronic medical record in the Yale-New Haven Health System with AF who are at risk for stroke and ensuring that they receive the appropriate anticoagulation or LAAO treatments in a standardized fashion.
Freeman also highlighted that about 65% of patients with AF are symptomatic with almost 20% reporting severe or disabling symptoms. For these patients, medical treatment with anti-arrhythmic medications or catheter ablation can significantly reduce AF burden and symptoms, improve quality of life and decrease the cost of care.
Freeman concluded his talk with an overview of how therapies like the DOAC treatment, LAAO, and catheter ablation have improved patient outcomes over the last 20 years. To learn more about Freeman’s work, watch the Grand Rounds video (YSM faculty) or review his bio.