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P07 - Improving Detection of Obstructive Sleep Apnea in Patients with Atrial Fibrillation

Affecting 6.1 million people, atrial fibrillation (AF) increases the risk for stroke five-fold and heart failure three-fold, causes significant morbidity and mortality, and is the leading arrhythmogenic cause for hospitalization. With the prevalence of AF projected to triple by 2050, incident AF primarily occurs in people 65 years and older and increases exponentially with age. Lifetime and cumulative risk of incident AF is estimated to be 1 in 4 people 55 years and older. As an independent risk factor for AF, obstructive sleep apnea (OSA) increases the risk for incident AF three-fold, remains undiagnosed in 80% of the general population, and is present in nearly half of people with AF. While OSA treatment with continuous positive airway pressure reduces the relative risk for recurrent AF by 42%, approximately 66% of people with AF have never had OSA screening. The purpose of this quality improvement project is to promote early OSA screening, diagnosis, and treatment in adult patients with AF by implementing an inpatient OSA bundle.  Pender’s Health Promotion Model underpins implementation; people are more likely to commit to health-promoting behaviors when they understand what health benefits are achievable. Eligible hospitalized patients with AF activate an OSA bundle, beginning with screening using the STOP-Bang questionnaire. A STOP-Bang score of three or higher initiates patient-targeted education about OSA and AF's arrhythmogenic relationship. At discharge, patients receive a sleep test appointment, sleep clinic appointment, or an ambulatory referral to a sleep clinic. After three months, a retrospective evaluation will determine if patients were seen in a sleep clinic, completed sleep testing, were diagnosed with OSA, or started positive-airway pressure therapy. Results are expected Fall 2021. As the general population ages, nurse practitioners will care for a growing number of patients with AF. This population experiences serious and life-threatening complications and a predisposition to frequent hospitalization, contributing to diminished quality of life. Importantly, this project aligns with Healthy People 2030’s national objective to reduce stroke deaths over the next ten years. Reliable and expeditious screening, diagnosis, and treatment of OSA in people with AF aim to reduce morbidity and mortality and improve resource utilization. 

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.