A pilot study of the quality of care of atrial fibrillation in Irish general practice

Fam Pract. 2024 Jan 30:cmae001. doi: 10.1093/fampra/cmae001. Online ahead of print.

Abstract

Background: Worldwide, atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults and poses a significant burden to patients, physicians, and healthcare systems. We developed a quality of care score based on the Atrial Fibrillation Better Care pathway recommended by the European Society of Cardiology and the European Heart Rhythm Association guidelines. This is a 14-point score that we have termed the MAGIC score(Management of Atrial Fibrillation in Integrated Care and General Practice).

Objective: The objective of this pilot study was to develop and test a quality of care score for patients with permanent AF in general practice.

Methods: An observational cross-sectional pilot study was undertaken. Proportionate sampling was used across 11 practices from the Ireland East practice-based research network. The GPs completed a report form on each patient by undertaking a retrospective chart review. Eleven practices participated with a total of 1855 patients with AF. We received data on 153 patients.

Results: The main findings were that no patient met all 14 guideline based recommendations. The mean MAGIC score was 11.3. Points were most commonly deducted because the creatinine clearance and HAS-BLED score were not recorded, and the patient was not on the correct dose of oral anti-coagulation.

Conclusion: This study demonstrates the feasibility of using a quality of care score to measure the quality of AF management in general practice. This scoring system, which is based on internationally recognized quality of care markers, highlights key areas that can be targeted with quality improvement intervention.

Keywords: Ireland; atrial fibrillation; general practice; guideline adherence; observational study; quality of health care.

Plain language summary

Atrial fibrillation (AF) is the most common arrhythmia in the world. An arrhythmia is when your heart beats in a disorganized way with no pattern. AF is a serious health problem because this rhythm can lead to other heart problems, stroke, and even death. Even though it is common, we know that people with AF do not always receive the correct treatment and monitoring. Treatment aims to control the heart rate, rhythm and minimize blood clot formation. Treating patients according to recommended guidelines will improve their medical care and outcomes. We created a 14-point quality-of-care score based on international clinical practice guidelines. This project was done to check if this score was practical to use and if it showed any patterns in the quality of care being delivered. Eleven GP practices from the Southeast of Ireland participated and gave us information on 153 patients with AF. We assigned each chart a quality-of-care score based on the tool we developed. No chart scored 14 points (full marks). The most common reasons for points being deducted were not recording kidney function, bleeding risk, and the patients being on the wrong dose of medication. With this information, we can now move forward and try to improve care for these patients by targeting the highlighted deficits.