PROGRAM OVERVIEW:

Atrial fibrillation (AF) is the most common cardiac arrhythmia. It is estimated that 2.5 million Americans have AF. The prevalence of AF has increased in recent years, due to the aging of the population and an increased prevalence of chronic heart disease. AF prevalence rises with age, and reaches about 8% after the age of 80. The median age of AF patients is about 75 years. Thromboembolic events related to atrial fibrillation result in significant morbidity, mortality and increases in the cost of healthcare. The rate of ischemic stroke in AF patients is ~5% year, 2 to 7 times the rate of persons without AF. Thirty-day stroke mortality in AF patients has been estimated at 24%. 

 

Oral anticoagulants are the agents indicated for long-term prevention and treatment of thromboembolic disorders.  Although stroke prophylaxis with the vitamin K antagonist warfarin has proven efficacy, it has numerous limitations: including slow onset of action, narrow therapeutic window, numerous food/drug and drug/drug interactions, and need for frequent monitoring.

 

Several new pharmacologic agents indicated for the reduction of stroke risk in patients with non-valvular atrial fibrillation have been approved by the FDA since 2010 and additional agents are in development.  These new agents target different factors (thrombin and Factor 10a respectively) in the coagulation cascade than does warfarin (which targets vitamin K dependent factors).  The availability of these new classes of agents has exploded the information that clinicians caring for these complex patients require. Physicians and advanced practice nurses who prescribe therapy as well as registered nurses who have key roles in follow up, monitoring, and patient education need comprehensive education to care for patients safely and to advise patients credibly.  

 

Studies have demonstrated significant gaps in AF patients' knowledge about their condition, as well as knowledge of the risks and benefits of the treatment they are currently taking for their AF despite their disease being treated for several years. One of the most important attributes of patient-centered care is active patient participation in the decision-making process. SDM, described as “the pinnacle of patient-centered care”, is characterized by patient and clinician partnership, exchange of the clinician’s research evidence and clinical expertise and the patient’s knowledge and experience with the options and their relative pros and cons, joint deliberation considering the pros and cons of each option, and agreement about which treatment to implement. SDM, characterized by patient participation in clinical decision making is a potentially powerful tool to increase the patient-centered nature of AF management.

 

PCNA, HRS and CEHI partnered to create this professional education webinar series which incorporates a patient-centered approach to reducing cardioembolic risk in patients with Non-Valvular Atrial Fibrillation (NVAF). 

 

The intent of this program is to leverage the respective strengths of medicine, nursing, and pharmacy to educate learners on a patient-centered approach to safely and effectively reducing stroke risk in the patient with non-valvular atrial fibrillation. Our three faculty bring broad and deep expertise in this field. We hope that you will find the content informative, and that you are engaged by the dialogue as all three experts weigh in on challenges that are encountered in real clinical practice settings. 

 

EDUCATIONAL OBJECTIVES: 

 

• Identify the factor(s) in the coagulation cascade on which warfarin, dabigatran, rivaroxaban and apixaban exert their respective anticoagulant effects 
• Identify sources for evidence-based guidelines for antithrombotic therapy in the reduction of cardioembolic risk in the patient with non-valvular atrial fibrillation. 
• Define the impact of renal function, clinical history, and patient age on the choice of anticoagulant agent 
• Describe the role of effective clinician/patient communication in the safe management of oral anticoagulation
• Outline an efficient method of incorporating shared decision making when developing a treatment plan for the patient with NVAF 

 

 

AUDIENCE:

Physicians

Nurses, advanced practice nurses 

 

FACULTY:

DAVID CALLANS MD FACC

Associate Director, Electrophysiology 

University of Pennsylvania Health System 

Professor of Medicine at the Hospital of the University of Pennsylvania and the Presbyterian Medical Center of Philadelphia

 

EILEEN HANDBERG PhD, ARNP, BC, FAHA, FACC

Associate Professor of Medicine, Division of Cardiovascular Medicine, University of Florida College of Medicine

Director of Clinical Programs, Division of Cardiovascular Medicine, 

University of Florida College of Medicine

 

KELLY RUDD PharmD, BCPS, CACP

Network Coordinator of Anticoagulation Services

Clinical Specialist, Anticoagulation, Bassett Medical Center, Cooperstown, New York

Clinical Faculty 

Columbia University College of Physicians & Surgeons, 

New York, New York

 

FACULTY DISCLOSURES:

Dr. Callans has disclosed that he has served as a consultant/advisory board member for Medtronic and for Biosense Webster.

 

Dr. Handberg has disclosed that she has received Grant/Research Support from Gilead and Daiichi Sankyo. She serves as program and CME Coordinator for Vascular Biology Working Group (VBWG), which receives sponsorship from Vessex, Genentech, Mesoblast, Daiichi-Sankyo, Sanofi, Esperion Therapeutics, ISIS Pharmaceuticals, United Therapeutics, Catabasis, Amarin, Cytori, AstraZeneca, Amgen, and Medtronic.

 

Dr. Rudd reported no commercial relationships with industry relative to the content of this program. 

 

COST: 

This online educational activity is offered free of charge. 

 

CONTINUING EDUCATION:

CE for nurses: RN, NP: 2.25 contact hours, one hour of which is pharmacology content. 

CME:

The HRS is awarding CME for our physician colleagues for this program. If you are a physician, please visit the HRS learning library to access this program: http://education.hrsonline.org/Users/ProductDetails.aspx?ActivityID=725

 

 

PARTICIPATION IN THE ACTIVITY AND RECEIPT OF CERTIFICATE OF CREDIT: 

Log in, complete the pretest, watch both sections of this activity, complete the post-test with score of > 75% (may take post-test more than once), and complete brief CE evaluation. You will be able to download a copy of your CE certificate.

 

ACCREDITOR: 

This educational activity is provided by the Preventive Cardiovascular Nurses Association (PCNA). PCNA is approved as a provider of nurse practitioner continuing education (CE) programs by the American Association of Nurse Practitioners (AANP), provider number 030602. This program is accredited for 1 contact hour of continuing education. This program was planned in accordance with AANP CE Policies and Commercial Support Standards.

 

SUPPORT

This activity is supported in part by Bristol-Myers Squibb and Pfizer, Inc.

Introduction

Part One

Part Two

Individual topic purchase: Selected