The Leeds Teaching Hospitals NHS Trust

Nurse delivered rapid access AF clinic

The rapid access Atrial Fibrillation (AF) clinic is an option primarily for patients with a new onset of AF to be referred by their GP and seen quickly in cardiology. Referrals are accepted from other specialities and a form for referral is available on Leeds Health Pathways. The primary focus of the clinics is stroke risk assessment and consideration for anticoagulation therapy for stroke prevention.

Patients are clinically assessed by the arrhythmia nurse specialists to:

  • Confirm a diagnosis of Atrial Fibrillation
  • Achieve heart rate control
  • Determine suitability for restoration of normal rhythm
  • Recognise significant other cardiac disease requiring further cardiologist input
  • Address the risk of stroke in AF and to assess the patient’s preferences for treatment.

Following investigation with ECG and echocardiography patients undergo a comprehensive review with the arrhythmia nurses and a treatment plan is agreed and started.

There is current capacity for 15 new patients per week, so we encourage referral directly to Leeds Oral Anticoagulant Service to commence warfarin when a diagnosis of AF is clear without intrusive symptoms, with good heart rate control and the balance of stroke risk is clearly greater than the risk of major bleeding on anticoagulation. However demand is rising because managing AF is not always this straightforward.

Our data suggests that:

  • 50% of patients require one single attendance and treatment is continued in the community
  • 15% are referred on for further cardiology or EP review
  • 15% are booked in for Cardioversion treatment to attempt restoration of normal heart rhythm
  • 20% require follow up in the AF clinic following further investigation.

Over 90% of patients with an elevated risk for stroke in AF become established on anticoagulation from the clinic, in comparison to a national average of 53%.

We aim to see patients within two weeks.

We deliver a high quality service and have been approached by the National Institute of Clinical Excellence (NICE) to present the clinic as an example of how their recently updated guidance can be successfully delivered.