Improving risk factor management in atrial fibrillation: a quality improvement project at a district general hospital

Background

Atrial fibrillation (AF) is a common arrhythmia associated with several modifiable cardiovascular risk factors [1,2]. Effective identification and management of these factors are key to reducing morbidity and supporting long term control [2,3,4]. An initial audit conducted with data collected from July 2023 at District General Hospital highlighted significant gaps in documentation and management of AF related comorbidities.

Purpose

To improve the recognition and management of modifiable risk factors in patients admitted with AF, including alcohol use, hypertension, heart failure, diabetes, obesity, and obstructive sleep apnoea (OSA) and thereby potentially improve patient outcomes and reduce recurrence.

Methods

The baseline audit included 150 patients with a primary diagnosis of AF in July 2023. Data was collected on documentation, optimisation of comorbidities, and evidence of management plans. Following this, a multi-faceted intervention was introduced:

1- Circulation of an educational e-mail to clinicians on acute medical take outlining key AF risk factors and management principles.

2- A teaching session was delivered physicians on the Acute Medical Unit about the importance of risk factor management, documentation and practical implementation strategies.

3- Development of an AF lifestyle and risk factor patient information leaflet, incorporated into nursing checklists and handover for admitted patients.

Re-audit cycles were then conducted over two distinct periods between January and April 2025

Results

The initial audit data showed suboptimal assessment and management of risk factors of AF, particularly OSA screening/consideration and advice on alcohol reduction, of which only 6% and 29% of the sample population received respectively. Hence, several meaningful improvements were achieved across key areas of care seen in table 1. Documentation of alcohol intake increased substantially from 15% to 92%, while the proportion of patients receiving alcohol related advice increased from 29% to 62%. Importantly, counselling included specific guidance to limit alcohol consumption to no more than three drinks, or approximately 30 grams per week. Hypertension management demonstrated optimal control in 75% of patients, with all having a clear intensification plan in place consistent with international guidelines. Comparable results were seen in the management of heart failure and diabetes, where 100% of patients had active intensification strategies by cycle 3. Modest but meaningful gains were seen in lifestyle measures, with weight loss advice increasing from 21% to 42% and OSA recognition improving from 6% to 32%..

Conclusion

This audit demonstrates that a targeted, education driven intervention combined with patient information tools can significantly enhance risk factor management in AF. Future work will focus on sustaining improvements and embedding structured checklists. Promoting staff awareness was key to sustainability.