Stories: Voices from the frontline
David H. Lam, M.D., and Adam H. Zivin, M.D.
More than 12 million American are expected to have atrial fibrillation (AFib) by the end of this decade. A form of irregular heartbeat, AFib brings with it the possibility of serious long-term complications, including an increased risk of heart failure, stroke and heart attack. And while a procedure called ablation can treat AFib, it’s not always a slam dunk—especially if the patient’s underlying risk factors aren’t addressed.
We’re rethinking treatment for patients with AFib. With the recent launch of the Swedish Comprehensive AFib Network (SCAN), we’re offering these patients a more holistic option that emphasizes the need to treat the causes, not just the disease. We sat down with SCAN’s co-medical directors, David H. Lam, M.D., and Adam H. Zivin, M.D., to discuss their plans for the program, the future of AFib treatment and the cardiac benefits of a little tough love.
You are the co-medical directors for SCAN. What does that mean?
DL: It means Swedish is re-imagining how we care for the patient with atrial fibrillation. This involves building a centralized care team of professionals and specialists focused on addressing risk factors that can lead to atrial fibrillation.
Prior to SCAN, how did we care for patients with AFib?
DL: We typically discover a patient has AFib when they end up in the emergency department. Once they’re stabilized, the ED doc will usually send them out to follow up with their primary care physician or refer them to a cardiologist. Unfortunately, we’ve found that most of the time, that transition gets lost and the patient can’t follow up or it takes too long and they end up going back to the ED several times. Healthcare can be very frustrating to navigate.
How do we plan to fix that with SCAN?
DL: We’re developing a whole-person wellness program that addresses a lot of the risk factors associated with AFib, which include hypertension, obesity, sleep apnea, substance abuse, metabolic conditions—many of which aren’t currently being addressed. Our goal is to link up patients with specialists right away.
You mentioned that it can already be difficult to get patients to follow up on referrals, so how do you plan to ensure that they navigate the new process and stay on track?
AZ: We have added a program coordinator to our team who’s willing to use a little tough love, because in my experience, what patients say and do are very different. They may say they’ll change the way they eat or their exercise habits or they’ll use a CPAP machine, but they don’t necessarily follow through. We’re asking them to potentially make several lifestyle changes, so it will be important that they feel accountable.
Speaking of which, will we continue to offer ablation as a treatment through SCAN?
AZ: Yes, ablation is one treatment that SCAN offers. But there’s plenty of data that shows that if you have a BMI over 35, ablation has a poor success rate. Similarly, it doesn’t work as well if your blood pressure or diabetes isn’t controlled. It doesn’t work very well if your sleep apnea is not managed.
DL: The main focus of our program will be on the preventative and wellness sides, addressing the other risk factors that people don’t like to talk about. Weight loss and a healthy lifestyle are going to have more long-term benefits than any procedure on its own. That’s the strength of this program.
AZ: If we have a patient referred to us for ablation but they don’t end up needing one because they engage in their own wellness, get their sleep apnea addressed and lose 50 pounds, that’s a win.
The collection and analysis of patient data will also be an important component of SCAN. Can you explain how and why?
DL: We’re planning to develop a registry of AFib patients so we can capture data on a bigger level and figure out where the gaps and variations are in our care.
AZ: We know, for instance, how many people come in to the ED or primary care with AFib. But we don’t know how many people get referred and see a cardiologist but get suboptimal treatment. We don’t know how many people get referred, see a cardiologist but get inappropriate treatment. Until we do—and that’s what the informaticist will help us with—it’s difficult to get our arms around how many patients out there have AFib and how to make sure they do get the correct treatment.
What about SCAN’s approach to treating AFib excites you?
AZ: Atrial fibrillation clinics are sprouting like mushrooms because AFib is a huge problem. An AFib clinic sounds exciting and is a good way to get people in for a procedure, but we want SCAN to be a fundamentally different approach.
DL: The American Heart Association recently published a position statement that finally recognizes that lifestyle modification should really be on the frontline of atrial fibrillation care, and that’s exactly where our clinic will focus. The medical community is finally recognizing that there are a lot of non-procedural, non-cardiology aspects of AFib that aren’t addressed. Lifestyle modification should really be on the frontline of AFib care.
How can philanthropy help?
DL: Data analysis and collection are foundational to SCAN, so growing that part of our team will continue to be very important. It’s how we’ll identify those gaps in care, determine what treatments and approaches work for what patients, and help them manage their condition in a more sustainable way. Having the people in place to make that happen will be one of the keys to SCAN’s success.
For more information on how you can support innovative, holistic healthcare for patients with atrial fibrillation, contact Libby Manthei at 206-215-2249 or [email protected].