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AF Diagnosis and Management

CE / CME

Atrial Fibrillation Case Considerations: Diagnosis and Screening

Physician Assistants/Physician Associates: 0.50 AAPA Category 1 CME credit

Nurses: 0.50 Nursing contact hour

Physicians: maximum of 0.50 AMA PRA Category 1 Credit™

Released: December 29, 2023

Expiration: December 28, 2024

Camille Dyer
Camille Dyer, MS, PA-C, AACC, DFAAPA
CME/CE Information

Activity

Progress
1 2
Course Completed

History
Mrs. Sims is a 75-year-old woman who presents to her primary care provider for her annual physical. Her past medical history includes type 2 diabetes, chronic obstructive pulmonary disease (COPD), obesity, hyperlipidemia, hypertension, heart failure with improved ejection fraction, hypothyroidism, and depression. She does not drink alcohol but has a 15 pack-year smoking history (quit 20 years ago). Her current medications include metformin ER 1000 mg twice daily, empagliflozin 25 mg daily, sacubitril/valsartan 49/51 mg twice daily, spironolactone 25 mg daily, carvedilol 12.5 mg twice daily, atorvastatin 40 mg daily, levothyroxine 112 mg daily, sertraline 25 mg daily, and acetaminophen 650 mg as needed.

Current Presentation
The patient states that she has been doing well and has no concerns about her health. She reports taking and tolerating her current medications but states that she would prefer to take fewer medications to minimize costs. She has been trying to lose weight and has signed up for a senior center, to which she takes the bus 3 times per week.

Her current vitals are blood pressure 138/88 mm Hg; pulse 120 beats/min; height 5 ft, 5 in; weight 93 kg; BMI 34.1 kg/m2. Recent labs show an A1C of 7.2%, urine albumin–creatinine ratio 20 mg/g, and estimated glomerular filtration rate 83 mL/min/1.73 m2. Her ejection fraction is 55% (improved from 35% at time of diagnosis). Her total cholesterol is 226 mg/dL, low-density lipoprotein 136 mg/dL, high-density lipoprotein 40 mg/dL, triglycerides 250 mg/dL. Her thyroid-stimulating hormone (TSH) from 2 years ago is 1.3, and her free T4 is 0.94. All other labs are within normal limits. She has Medicare Part D insurance, is on a fixed income, and lives alone in her retirement. Her family checks on her 1-2 times per month.

Question A

Which of her comorbidities puts her at risk for developing atrial fibrillation and should be addressed during today’s visit?