Authors (including presenting author) :
Fong HM(1), Hui TH(1), Yu CT(2), Tam YM(1), Hui KF(1)
Affiliation :
(1)Department of Medicine and Geriatric, (2)Nursing Services Division, United Christian HospitalFAS
Introduction :
Introduction:
Atrial fibrillation (AF) has a 4- to 5-fold increase in stroke risk. Oral anticoagulants (OAC) are effective in preventing AF-associated stroke, especially for patients with moderate to high risk of thromboembolic events. Being a key role in stroke reduction, OAC can also reduce stroke severity and improve functional outcome.
FAST clinic was launched on 22 April 2021 in United Christian Hospital to allow prompt treatment for newly diagnosed AF patients in an out-patient setting.
Objectives :
Objectives:
1. Provide a fast-track service for newly diagnosed AF patients on health education
2. Initiate an appropriate antithrombotic therapy
3. Reduce the risk of fatal and disabling stroke
Methodology :
Methodology:
FAST clinic is held twice weekly, a co-joint clinic run by neurologists and stroke nurses. Patients are mainly referred from Family Medicine and GOPD, and are initially seen by stroke nurses who provide health education, initial assessment and arrange necessary investigations. The neurologists' consultation is arranged 2 weeks later to provide further evaluation and initiate appropriate antithrombotic therapy.
Result & Outcome :
Results:
From 22 April 2021 to 31 October 2022, 114 patients were referred to FAST clinic. Of these, 67 (59%) were male. The mean age was 72 years. The mean CHA2DS2VASc score was 2.48 and 3.68 in the male and female group, respectively. The time from upon receiving the referral letters to their first visit in FAST clinic has been shortened by approximately 8 weeks.
After assessment, 84.2% of the subjects agreed to start OAC. Among the 18 subjects who did not receive OAC, 11 were ineligible and the remaining declined due to personal reasons.
For the 1-year outcome, sixty-eight subjects were analyzed. There were 4 (5.9%) subjects suffered from stroke with half of them not even taking any antithrombotic agent. For the two subjects who were on OAC, one suffered from transient ischemic attack and the other from hemorrhagic stroke. Four deaths occurred during the study period, and one was caused by hemorrhagic stroke, while the other three were due to events unrelated to stroke.
Conclusion:
FAST clinic is effective in providing fast-track management for newly diagnosed AF patients. With the concerted effort of both stroke nurses and neurologists, AF patients can benefit from appropriate treatment and intervention thereby reducing the incidence of ischemic stroke.
