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Stanford University School of Medicine

Cardiology care associated with lower risk of stroke in a-fib patients

Patients diagnosed with the common heart condition atrial fibrillation face a daunting set of choices for treatment, according to Mintu Turakhia, MD, associate professor of medicine at Stanford.

Turakhia, who specializes in heart-rhythm disorders, set out to examine which types of care received within the first 90 days of diagnosis led to the best outcomes. In addition, he also looked to see if there was a difference between patients treated by primary care doctors and seen by specialists.

His study, which appears today in the Journal of the American College of Cardiology, found that the risk of stroke was reduced by 9 percent in patients who received cardiology care during those first three months after diagnosis. The death rate dropped by 11 percent. This appears to be due to the fact that cardiologists were more likely to prescribe blood-thinning medications known as anticoagulants, the study said.

"The important message here is that getting early cardiology care was associated with early prescription of drugs specifically for preventing stroke," said Turakhia, in a press release I wrote on the research. "These findings show that it is important to think of these interventions at the time of diagnosis."

The press release describes how Turakhia and his team analyzed records from 184,161 patients newly diagnosed with atrial fibrillation between 2004 and 2012 from the U.S. Department of Veterans Affairs health care system. Within 90 days of diagnosis, 40 percent received cardiology care and 60 percent received primary care without being referred to a cardiologist. Those patients who who saw cardiologists were also more likely to be given anticoagulants, which is used to prevent blood clots and can lower the risk of stroke.

This was an observational study, Turakhia points out, and is not evidence that cardiologists are preferable to primary care physicians as care providers for atrial fibrillation patients. Instead, he says it suggests that alternative methods of providing health care, such as video conferencing appointments or scheduling joint consultations, should be considered in order to provide patients with the best care possible. He discusses this in the press release:

We’re not saying that we just need to clone more cardiologists — that is exactly the wrong solution. Rather, this research indicates that we need to fill gaps in care and find smarter ways to deliver it so it doesn’t matter who a patient sees or how far away they live.

Previously: Using big data to improve patient care researchers explore a-fib treatments, A little help from pharmacists helps a-fib patients adhere to prescriptions and Study highlights increased risk of death among patients with atrial fibrillation who take digoxin
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