Patients with AF could benefit from CM
They need help adhering to medication regimen
Atrial fibrillation isn't typically a trigger for case management, but newly diagnosed patients would definitely benefit from case management interventions, says Teri Treiger, RN-C, MA, CCM, CCP, a case management consultant based in Holbrook, MA.
"If atrial fibrillation is the patient's sole problem, it's unlikely that a case manager would be involved in the individual plan of care, except perhaps when a hospital patient is transitioning to another setting or home care. Case management at many insurers focus on individuals based on historical costs related to the care. Someone with only atrial fibrillation who has just been diagnosed might not rise to that threshold," she adds.
Patients who are starting anticoagulation therapy need to have education about why it's important to take the medicine, the potential side effects, the importance of having regular blood tests performed, and what symptoms indicate that they should call the doctor, Treiger says.
"All of these are very standard types of case management interventions. We all know that an educated patient is a better patient. We can't control what people do with the information we give them, but we can give them what they need to know in an easy-to-understand form," she says.
People with atrial fibrillation often need a lot of education to understand the importance of medication adherence, she says.
"Anticoagulation therapy is complex and complicated for an individual to understand, and they often need guidance, particularly early in the process," she says.
Atrial fibrillation is the most common cardiac arrhythmia, and the diagnosis often takes patients by surprise, Treiger says.
Some patients are diagnosed when they make a visit to their physician or the emergency department because of heart palpitations or an episode of dizziness or fainting; but many times, patients with atrial fibrillation have had no symptoms and the condition is diagnosed during a routine physical examination or hospitalization for an unrelated condition.
"Newly diagnosed patients may have had an irregular heartbeat for years and never had a clue that they have atrial fibrillation. This presents a challenge in and of itself to convince them they need medication and multiple visits for blood work monitoring," she says.
Patients who don't take their anticoagulants as prescribed are at high risk for stroke, or they could have an episode of pre-syncope or syncope, Treiger points out.
People taking anticoagulants require a lot of monitoring and lab work, particularly when the condition is first diagnosed, and it's hard for many people to maintain the motivation to adhere to the regimen, she adds.
If their dosage isn't at the right level and their blood becomes too thin, they are at risk for internal bleeding, she points out.
"Lack of adherence with the prescribed treatment and follow-up could have very serious consequences and lead to a lifelong major disability for some patients, but it's hard to motivate patients to take medication for symptoms they don't feel they have," Treiger points out.
Many patients are resistant to anticoagulation medication at first, and some of those who have been on anticoagulation therapy for a while develop a level of complacency and think "everything's been fine before so I don't need to worry about this," she says.
Once patients are diagnosed with atrial fibrillation, they would benefit from education and other support, Treiger says.
"They may not rise to the level of needing intense case management, but they can benefit from education on the condition as well as support in adherence to their treatment plan," she adds.
Treiger suggests that hospital-based case managers spend time with patients with atrial fibrillation, educating them about their condition, the importance of taking their medication, and the consequences of following their treatment regimen.
"Case managers already are looking at medication reconciliation and developing a discharge plan for patients in the hospital. This is a good opportunity to make sure patients understand their condition and what could happen if they don't take their medication, fail to have regular bloodwork, or don't see a physician for follow up. This is all a part of transitions of care," she says.
Case managers who work at managed care organizations and see that a patient is newly diagnosed with atrial fibrillation should reach out to make sure the patient understands his or her diagnosis and treatment regimen.
"My concern is that if an individual is diagnosed with atrial fibrillation and is not already enrolled in a case management or disease management program, the condition might not be picked up in a straight utilization review. The utilization review nurse may be looking only at one particular incident of hospitalization and may not have other information," she says.
The patient-centered medical home is the perfect place for case managers to educate patients about their condition, she adds.
Physicians give patients prescriptions for anticoagulants, but they can't spend a lot of time educating patients about what they need to be mindful of or to call them on a regular basis to make sure they are following their treatment regimen, Treiger points out.
"Case management is different from clinical management. More and more we are going to see roles for case managers in medical homes to help individual patients understand and manage their conditions," she says.
Atrial fibrillation isn't typically a trigger for case management, but newly diagnosed patients would definitely benefit from case management interventions, says Teri Treiger, RN-C, MA, CCM, CCP, a case management consultant based in Holbrook, MA.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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