Professor Liu Tong of the Second Hospital of Tianjin Medical University shared the new concept of integrated management of atrial fibrillation. He noted in his report that adopting a structured patient-centered management model that integrates medical staff from different specialties can improve the quality of management of patients with atrial fibrillation.
Professor Liu Tong introduced that the management of atrial fibrillation mainly includes the following factors: early and timely (atrial fibrillation screening) interventions for atrial fibrillation (preferably before complications occur); long-term management for patients with atrial fibrillation.
Let patients understand their condition and learn to self-manage; evaluate the quality of integrated management of atrial fibrillation, early identification of patients who need specialist intervention and rapid classification; and interdisciplinary atrial fibrillation treatment teams develop appropriate management plans.
"In the diagnosis and screening of atrial fibrillation, attention should be paid to the recognition of asymptomatic atrial fibrillation", Professor Liu Tong emphasized, "asymptomatic atrial fibrillation is clinically common, and ecG testing of patients with symptomatic atrial fibrillation found that 70% of atrial fibrillation attacks were asymptomatic".
In addition, Atrial fibrillation screening in stroke patients can be performed on ecglycticography, he noted, he pointed out that long-range ECG testing found that many stroke patients have atrial fibrillation, especially in stroke patients of unknown cause or embolus of unknown origin, recommended for stroke patients and people at high risk of atrial fibrillation for at least 72 hours of ECG monitoring.
Professor Liu Tong introduced the five-ring principle of integrated management of atrial fibrillation recommended by esc guidelines: including stabilization of the disease in the acute phase, control of atrial fibrillation comorbidities and maintenance of hemodynamic stability; lifestyle adjustment, diagnosis and treatment of concomitant cardiovascular disease; stroke risk assessment and oral anticoagulant prevention of stroke; heart rate control; rhythm control.
Fig. 1 The five-ring principle of integrated management of atrial fibrillation
Figure 2 Integrated management model of atrial fibrillation and atrial fibrillation cardiac team
In the integrated management model of atrial fibrillation, Professor Liu Tong stressed that newly diagnosed patients with atrial fibrillation should visit the core team of integrated management at least once, the main contents include: diagnostic assessment, discussion of treatment options, starting appropriate treatment according to guidelines, individualized education of patients and caregivers; stable patients with atrial fibrillation can self-manage themselves in the community.
The following patients should be re-contacted with the integrated management team of atrial fibrillation: clinical symptoms worsening, hospitalization, stroke or bleeding, hemodynamic instability or recurrence of acute symptomatic arrhythmias, or poor clinical management, the integrated management model team personnel should communicate more with patients with atrial fibrillation, provide patients with alternative treatment options, and provide technical support.
The Atrial Fibrillation-Cardiac team makes complex decisions primarily for patients who: (1) Rhythm control treatment strategies are difficult: Symptomatic atrial fibrillation catheter ablation failure, consider surgical treatment of atrial fibrillation. (2) Patients with contraindications to anticoagulation therapy require left atrial appendage occlusion or ligation.
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