Heart Treatment Centers Form Afib Alliance

The founding member hospitals of the National Alliance of Integrated Afib Centers say the top goals of the multidisciplinary, data-driven effort are to stop inappropriate cardiac procedures and to improve the quality of care.

Five heart treatment centers from across the country and a leading atrial fibrillation patient advocacy group for have formed a multidisciplinary alliance to treat people with irregular heartbeats.

The National Alliance of Integrated Afib Centers says there exists little coordination or data sharing about the heart ailment even though by some estimates that 5.1 million people in the United States have a cardiac rhythm disturbance, and that the number could grow to 15.9 million by 2050.

NAIAC President Jonathan Philpott, MD, a cardiothoracic surgeon at Sentara Heart Hospital in Norfolk, VA, says member hospitals will lead the nation in Afib research, foster and refine synergies among cardiac specialties for Afib patients, and parse mountains of specific patient data outcomes with a goal of sharing and standardizing best practices.

NAIAC's founding members are:

1. Sentara Heart Hospital – Norfolk, VA
2. Cedars-Sinai Heart Institute – Los Angeles, CA
3. St. Helena Arrhythmia Center – Napa Valley, CA
4. St. Vincent's Medical Center – Bridgeport, CT
5. Orlando Health Heart Institute – Orlando, FL
6. StopAfib.org 

"We share a common goal to improve the quality of care with folks who have Afib and to stop inappropriate procedures and go with more effective and more durable procedures," says Philpott, who is himself an Afib patient.

NAIAC will work with StopAfib.org to identify patients and steer them to the nearest member hospital. Each patient will be treated by a cardiothoracic surgeon who works with an electrophysiologist, and a patient care coordinator. The care team and the patient will design the best treatment care plan tailored to the patient's needs.

In a phone interview this week, Philpott spoke in detail about the goals and structure of NAIAC, which is up and running, and what it hopes to achieve. The following is an edited transcript.

HLM: How will NAIAC operate?

JP: The alliance is designed so that patients coming to it are going to see all of their options. When patients come to see a doctor, the doctor typically just talks about what it is they do. My group said this was an old way of thinking.

Let's do this as a heart team, where the patient comes in and you have all the experts there, anesthesia, cardiology, surgery, and let's figure out with everybody looking at the patient what the right thing is, instead of rewarding one group of people for volume.

HLM: Why did you select these five hospitals as founding members?

JP: What we tried to do is look across the country to find an initial group of centers that embraced this idea, but had also shown a good track record with all of the platforms—medical management, catheter ablation, hybrid ablation—and we are also facile with the full Cox maze procedure, which remains the gold standard.

It is interesting that when we started looking across the country there are not a lot that can do all that.

HLM: How exactly are you affiliated?

JP: We share a common goal to improve the quality of care with folks who have Afib and to stop inappropriate procedures and go with more effective and more durable procedures.

HLM: What will NAIAC centers do differently?

JP: We want to be data-driven. To be in the alliance you have to be able to offer those services, but you also have to agree that you will be wide open with your outcomes. To stay in the alliance you have to maintain the capabilities and volume and the ability to do all three of the interventions very well. But you also have to agree to share your data with the data base we are designing especially for the alliance.

The database is unique in that it is going to capture any type of ablation that is performed whether it is catheter or surgical and the follow up is going to be rigid within the first year at three, six, and nine months every year after that.

With all of the centers participating in the same way and following the data we will quickly be able to perform very fast quality improvement, not only amongst the centers but within each center.

HLM: Why does Afib need centers of excellence?

JP: I can tell you exactly right now what my coronary mortality rate is and so can any other surgeon who is worth their salt in the United States because it is tracked daily. If you look at transplants it's the same thing. You get to Afib and it's kind of like [you hear] crickets.

I want these centers to start off and say we are going to be data-driven and we are going to start shifting care to models that work and also save institutions down the road.

The old way was if a guy had a catheter ablation that failed he got rewarded and so did the institution. The patient would come back and have another catheter ablation and if that didn't work they still got rewarded for failure.

I see the future as teams being rewarded for quality. Maybe fewer procedures, but the ones that are performed are the ones that work.

The other part of the database I am most excited about is tracking readmissions. Afib readmissions are very common and super expensive. We have already seen here that the folks who got ablated up front cost a little bit more, in those cases, once we did it they quit coming back.

We wanted to build that into the database. Are we saving money over time by doing a higher quality ablation up front instead of multiple low quality ablations? That is going to be tracked. Overall costs, readmissions, the number of readmissions from complications from Afibs. For hospital administrators that is going to be fantastic data.

HLM: How do you determine who your patients will be?

JP: There is this big section of the population with Afib that have been treated once or twice, but they are highly dissatisfied and they don't know who to go to. That is the target group. We are looking for patients who are seeking education about an honest appraisal of where they are with their Afib and what their options may or may not be.

So, we set the whole thing up, we partnered with stopafib.org, which is also very motivated by the fact that there is this gigantic population of folks across the country with Afib who feel like they aren't getting the answers they need.

They developed a website that is the go to site for people with Afib. The whole idea is that if a new patient has Afib they would probably land on this site and it would link them to NAIAC and that would funnel them to one of the centers near them.

HLM: Do you expect more hospitals to join NAIAC?

JP: Absolutely. We wanted to work the kinks out in the first year, but next year we are going to start taking applications. We are already getting requests from multiple hospitals to join. The goal for us though is we can never let this turn into a marketing scheme.

It has to be a quality driven alliance. It is probably going to become an international site very quickly and in the next five years we would like to move to 30 sites minimum. But I don't want to turn it into 100-site thing. I'd rather it stick to maybe 20 or 30 sites across the country that are actually the real deal.

On the financial part, we probably just to keep the alliance growing are almost certainly going to have to demand dues from members. We talked about that but we haven't enacted it. That is probably going to start. The database is going to need a little bit of money but the participating institutions will pay a fee to use that.