Case 2: CB is a 77-year-old male who presents with a 3-month history of symptomatic PAF. His spells last up to 1 hour and occur now as frequently as once per week with a self-assessed pulse rate of 120 bpm during these events. (Afib Case 2)

Case Study

Faculty

Gerald V. Naccarelli, MD, FACC
Bernard Trabin Chair in Cardiology
Professor, Department of Medicine
Chief, Division of Cardiology
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine
Penn State Hershey Heart and Vascular Institute
Hershey, Pennsylvania

James A. Reiffel, MD
Professor of Clinical Medicine
Department of Medicine, Division of Cardiology
Columbia University Medical Center
New York, New York

Intended Learners

This activity is intended to meet the educational needs of cardiologists, EPs, and related healthcare professionals.

Learning Objectives

After completing this activity, participants should be able to:

Describe the clinical and cost impact of recurrent atrial fibrillation (AF) and related hospitalizations
Outline current clinical trial data on rate and rhythm control and their impact on cardiovascular outcomes
Identify stroke risk factors and implement the CHADS₂ score for AF stroke risk assessment
Summarize the latest clinical trial data for current and emerging anticoagulants for stroke prevention in patients with AF
Employ guideline-directed and evidence-based practice for appropriate use of rate and rhythm control and stroke prevention in patients with AF

Activity Overview

This on-demand case vignette activity consists of a patient case study, with polling questions integrated throughout the case.

Nurse and Pharmacist Participants

To be eligible for documentation of credit, participants must review the case study, answer all polling questions, complete the 5-question online post-test with a score of 80% or better, and complete the evaluation form. After successful completion of the post-test and evaluation form online at www.naccme.com, nurse and pharmacist participants may immediately print their documentation of credit.

Physician Participants

After successful completion of the post-test and NACCME evaluation, physician participants will be directed to the VHA website to complete a brief survey. After successful completion of the survey, physician participants will be able to print their certificate of credit.

Release date: July 19, 2011
Expiration date: July 19, 2012
Estimated time to complete: .5 hour

There is no fee associated with this activity.
This educational activity is a knowledge-based activity.
For questions regarding this activity, please call 609-371-1137.

Hardware/Software Requirements

All educational activities are accessible via a computer with 650 MHz PC, 128 MB RAM, Windows or MAC operating system, Internet Explorer, Netscape, or Safari browsers. Windows Media Player, sound card, and speakers are required for streamed audio. Flash Player, sound card, and speakers are required for video programs. A PDF reader is required for print publications. Please direct technical questions to webmaster@naccme.com.

CME Accreditation

VHA Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

VHA Inc. designates this enduring material for a maximum of .5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CNE Accreditation

North American Center for Continuing Medical Education, LLC (NACCME) is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

This continuing nursing education activity was approved for .5 contact hour.

Provider approved by the California Board of Registered Nursing, Provider #13255 for .5 contact hour.

CPE Accreditation

North American Center for Continuing Medical Education, LLC (NACCME) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This activity is approved for 0.5 contact hour (0.05 CEU) of continuing pharmacy education (UAN 276-999-11-038-H01-P).

Any participant wanting to file a grievance with respect to any aspect of a continuing pharmacy education activity accredited by NACCME may contact the Assistant Director, Accreditation Services, NACCME, in writing at 300 Rike Drive, Suite A, Millstone Township, NJ 08535. The Assistant Director, Accreditation Services will review the grievance and respond within 30 days of receiving the written statement. If the participant is unsatisfied with the response, an appeal to the Senior Director, Accreditation Services, NACCME, may be made for a second level of review.

Independent Clinical Reviewer: Marco Mercader, MD, George Washington University, Washington, D.C.

Nurse Reviewer: Marsha Holton, CCRN, RCIS, FSICP, Cardiovascular Orientation Programs, Indian Head, Maryland

Planning Committee

The planning committee comprises Marsha Holton, CCRN, RCIS, FSICP, Marco Mercader, MD, Gerald V. Naccarelli, MD, FACC, James A. Reiffel, MD; Peggy L. Naas, MD, John Pevoto, VHA Inc.; Brian Lee, PharmD, Horizon CME; Stephen Chavez, Mary Johnson, Stacey Ohana, Randy Robbin, and John Savage, North American Center for Continuing Medical Education, LLC (NACCME).

Financial Disclosure and Conflicts of Interest

According to the disclosure policy of NACCME and VHA, faculty, editors, managers, and other individuals who are in a position to control content are required to disclose any relevant financial relationships with relevant commercial companies related to this activity. All relevant conflicts of interest that are identified are reviewed for potential conflicts of interest. If a conflict is identified, it is the responsibility of NACCME and VHA to initiate a mechanism to resolve the conflict(s). The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation.

All educational materials are reviewed for fair balance, scientific objectivity of studies reported, and levels of evidence.

The faculty has reported the following:
Ms. Holton has disclosed no relevant financial relationships with any commercial interest
Dr. Mercader: Grant/research support—George Washington University/Medical Faculty Associates Collaborative Grant, Cheney Cardiovascular Institute Grant; Speaker—Biotronik
Approaches
Dr. Naccarelli: Grant/research support—Astellas, Boehringer Ingelheim, GlaxoSmithKline; Consultant—AstraZeneca, Biocritique, Biosense Webster, Blue Ash,Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Gilead, GlaxoSmithKline, Medtronic, Inc, Merck, Novartis, Ortho-McNeil-Janssen, Otsuka Pharmaceuticals, Pfizer, Portola, sanofi-aventis, U.S., St. Jude Medical, Xention
Dr. Reiffel: Grant/research support—Boehringer Ingelheim, GlaxoSmithKline; Consultant—Boehringer Ingelheim, Cardiome, Gilead, Merck, sanofi-aventis, U.S.; Scientific advisor—Boehringer Ingelheim, Cardiome, Gilead, Merck, sanofi-aventis, U.S.; Promotional speakers bureau—Boehringer Ingelheim, sanofi-aventis, U.S.

Mr. Chavez, Ms. Johnson, Dr. Lee, Dr. Naas, Ms. Ohana, Mr. Pevoto, Mr. Robbin, and Mr. Savage have disclosed no relevant financial relationships with any commercial interests.

NACCME and VHA Inc. require faculty to inform participants whenever off-label/unapproved uses of drugs and/or devices are discussed in their presentations.

The faculty has disclosed that off-label uses of some products may be discussed during this presentation: amiodarone, clopidogrel.

NACCME protects the privacy of personal and other information regarding participants, educational partners, and joint sponsors. NACCME and our joint sponsors will not release personally identifiable information to a third party without the individual’s consent, except such information as is required for reporting purposes to the appropriate accrediting agency.

NACCME maintains physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

Copyright © 2011 by North American Center for Continuing Medical Education, LLC. All rights reserved. No part of this accredited continuing education activity may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from North American Center for Continuing Medical Education.

Grant Support

Supported by an independent educational grant from sanofi-aventis, U.S., Bristol-Myers Squibb and Pfizer, Inc., and Boehringer Ingelheim