AFIB SUMMIT 2015

1. Subodh K. Agrawal, MD
• Interventional Cardiologist at
Athens Heart Center
• Board Certified in Internal
Medicine, Cardiovascular
Diseases, Interventional
Cardiology, and Sleep Medicine
• Special interests are coronary
artery disease, sleep disorders
and their connection to cardiac
function, healthcare education,
and finding ways to help reduce
costs while improving the quality
of healthcare in the U.S.
Medical School:
Sawai Man Singh Medical College
Residency:
Emory University
Hospital
Fellowship:
Emory University
Hospital

3. Government
• The U.S. Congress recognizes the need for
more AF awareness.
• On September 11, 2009, the U.S. Senate
declared it National Atrial Fibrillation
Awareness Month.

4. 2015 Doctors ACO, LLC 4

5. The Ultimate Physician Challenge
5

6. % of Total Cost
Hospitalizations
Drugs
Consultations
Further
Investigations
Paramedical
Procedures
Loss of Work
23%
9%
8%
2%
6%
52%
Major Costs in Treatment of AF
Le Heuzey JY, et al. Am Heart J (2004) 147:121
COCAF Study

7. CMS - Medicare Progress in 3 years:
405 ACOs Nationwide in 2015
More than 20% of all Medicare Patients in ACOs
56 Million Total Medicare Patients with
11.5 Million Medicare Patients in ACOs
Change is Happening….
2015 Doctors ACO, LLC 7

8. Good to Great

9. Atrial fibrillation and Anticoagulation
Quality of your Practice
Are you following guidelines ?
If not are you documenting Why Not?
Subodh K. Agrawal, MD
Noelle Lamberth, CIO
Athens Heart Center
Tom Heard, R.Ph., CGP
Kim Nolen, PharmD
Medical Outcomes Specialist,
Pfizer, Inc

10. Results
There were 337 NVAF patients evaluated in this analysis. Age and gender of the patients are
presented in Table 1. The population had a mean age of 70.5 years with the greatest proportion
greater or equal to 75 years of age (38%). Over 55 percent of the patients were male and 42.1%
were female. (Data date range: 1/4/2013 – 8/29/2014)
Number (%) Mean ± SD Range
Age (years) 70.51 ± 11.2 34 - 90
Male 195 (57.9) 68.92 ± 10.71 41 - 90
Female 142 (42.1) 72.70 ± 11.54 34 - 90
Total 337 (100)
Table 1. Age and Gender
Number (%)
Age by Increment
18 – 44 7 (2.1)
45 – 54 19 (5.6)
55 – 64 69 (20.5)
65 – 74 114 (33.3)
≥ 75 128 (38.0)
Table 2. Age by Increment

11. Distribution of Stroke Risk Category CHADS2
Low Risk (n=25)
7.4%
Intermediate Risk
(n=79), 23.4%
High Risk (n=233)
69.1%
Low Risk (score = 0) Intermediate Risk (score = 1) High Risk (score ≥ 2)
The results obtained in an assessment of stroke risk, using the CHADS2 score, are
illustrated in Figure 1. The mean and standard deviation CHADS2 score among the
participants was 2.6 ± 1.55 (range: 0 – 6).

12. Current Anti-thrombotic Therapy Utilization Patterns
for All NVAF Patients
No Therapy, 21, 6%
ASA, 104, 31%
VKA, 27, 8%
VKA + ASA and/or
Antiplatelet, 24, 7%
NOAC, 89, 26%
NOAC + ASA and/or
Antiplatelet, 43, 13%
Antiplatelet + ASA,
13, 4%
Antiplatelet Alone,
16, 5%
 No Therapy = 6% (n=21)
 ASAAlone = 31% (n=104)
 Antiplatelet Alone = 5% (n=16)
 Antiplatelet + ASA = 4% (n=13)
 VKA ± ASA/Antiplatelet = 15% (n=51)
 NOAC ± ASA/Antiplatelet = 39% (n=132)

13. Patients with Therapy versus Patient without Therapy
316
21
0
50
100
150
200
250
300
350
Patients on Therapy No Therapy

14. Patients with or without documentation with no
therapy
Of the 337 patient evaluated, 21 patients were not on therapy. Of the 21
patients, some patients had documentation in the EMR while with other
patients no documentation was noted.
15
6
0
2
4
6
8
10
12
14
16
Documentation No Documentation

15. Continuous Cycle

16. Learn Together
At Events Like This One

17. Gain Independent Success

18. Celebrate With Your Patients

19. ANY QUESTIONS?