Subodh K. Agrawal, MD• Interventional Cardiologist at

Athens Heart Center

• Board Certified in Internal Medicine, CardiovascularDiseases, Interventional Cardiology, and Sleep Medicine

• Special interests are coronary artery disease, sleep disorders and their connection to cardiac function, healthcare education, and finding ways to help reducecosts while improving the quality of healthcare in the U.S.

Medical School:Sawai Man Singh Medical College

Residency:Emory University

Hospital

Fellowship: Emory University

Hospital

Government

• The U.S. Congress recognizes the need for more AF awareness.

• On September 11, 2009, the U.S. Senate declared it National Atrial Fibrillation Awareness Month.

2015 Doctors ACO, LLC 4

The Ultimate Physician Challenge

High quality clinical care delivery Cost efficient clinical care delivery Population health management

-Physicians must do all simultaneously

to deliver value ( Outcomes / Cost )

all with limited funds

5

% of Total Cost

Hospitalizations

Drugs

Consultations

Further Investiga-tions

Paramedical Procedures

Loss of Work

23%

9%

8%2%

6%

52%

Major Costs in Treatment of AF

Le Heuzey JY, et al. Am Heart J (2004) 147:121

COCAF Study

CMS - Medicare Progress in 3 years:

405 ACOs Nationwide in 2015

More than 20% of all Medicare Patients in ACOs

56 Million Total Medicare Patients with 11.5 Million Medicare Patients in ACOs

Change is Happening….

2015 Doctors ACO, LLC 7

Good to Great

Atrial fibrillation and Anticoagulation Quality of your Practice

Are you following guidelines ?If not are you documenting Why Not?

Subodh K. Agrawal, MDNoelle Lamberth, CIOAthens Heart Center

Tom Heard, R.Ph., CGPKim Nolen, PharmD

Medical Outcomes Specialist, Pfizer, Inc

ResultsThere were 337 NVAF patients evaluated in this analysis. Age and gender of the patients are presented in Table 1. The population had a mean age of 70.5 years with the greatest proportion greater or equal to 75 years of age (38%). Over 55 percent of the patients were male and 42.1% were female. (Data date range: 1/4/2013 – 8/29/2014)

Number (%) Mean ± SD RangeAge (years) 70.51 ± 11.2 34 - 90 Male 195 (57.9) 68.92 ± 10.71 41 - 90Female 142 (42.1) 72.70 ± 11.54 34 - 90

Total 337 (100)

Table 1. Age and Gender

Number (%)Age by Increment

18 – 44 7 (2.1)45 – 54 19 (5.6)55 – 64 69 (20.5)65 – 74 114 (33.3)

≥ 75 128 (38.0)

Table 2. Age by Increment

Distribution of Stroke Risk Category CHADS2

Low Risk (n=25) 7.4%

In-ter-

medi-ate

Risk (n=79)

, 23.4%

High Risk

(n=233)

69.1%Low Risk (score = 0) Intermediate Risk (score = 1) High Risk (score ≥ 2)

The results obtained in an assessment of stroke risk, using the CHADS2 score, are illustrated in Figure 1. The mean and standard deviation CHADS2 score among the participants was 2.6 ± 1.55 (range: 0 – 6).

Current Anti-thrombotic Therapy Utilization Patterns for All NVAF Patients

No Therapy, 21, 6%

ASA; 104; 31%

VKA, 27, 8%VKA + ASA and/or Antiplatelet; 24;

7%

NOAC, 89,

26%

NOAC + ASA and/or

An-tiplatelet; 43;

13%

An-tiplatel

et + ASA;

13; 4%

Antiplatelet Alone; 16; 5%

No Therapy = 6% (n=21) ASA Alone = 31% (n=104) Antiplatelet Alone = 5% (n=16) Antiplatelet + ASA = 4% (n=13) VKA ± ASA/Antiplatelet = 15% (n=51) NOAC ± ASA/Antiplatelet = 39% (n=132)

Patients with Therapy versus Patient without Therapy

Patients on Therapy No Therapy0

50

100

150

200

250

300

350316

21

Patients with or without documentation with no therapy

Of the 337 patient evaluated, 21 patients were not on therapy. Of the 21 patients, some patients had documentation in the EMR while with other patients no documentation was noted.

Documentation No Documentation0

2

4

6

8

10

12

14

16 15

6

Continuous Cycle

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