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CVForward  >  4 steps that will expand your LAAC patient population

4 steps that will expand your LAAC patient population


Amy Schwartz

Amy Schwartz

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As previously highlighted in The Value of an LAAC Coordinator article, investing in LAAC capability presents a rich opportunity for many cardiovascular service lines. As an LAAC coordinator at CHI Health Nebraska Heart, Amy Schwartz believes that most Left Atrial Appendage Closure (LAAC) programs have the potential to service many more patients. In fact, her team has led a highly successful effort to expand their patient population. This has had a beneficial impact on both her organization and the community it serves.

Here are the steps that allowed Amy Schwartz and her team to expand their LAAC patient population.


Step 1: Establish strong internal advocates

In my experience, it’s important that you get your physicians on board, whether it be your echocardiographer or your physician champion.”
  Amy Schwartz, BSN, RN
Structural Heart Coordinator
CHI Health Nebraska Heart

LAAC outreach efforts will only be as strong as the internal advocates who represent the LAAC program. Whether it be cardiologists, echocardiographers, or gastroenterologists, internal champions are a key component to outreach and expansion. These key players will perform an essential role toward developing a trusting relationship with the community physicians, who are so important to expanding the LAAC patient population.

It takes a constant and persistent effort to gain the trust of physicians in the community. A steady stream of education and awareness is needed. Colleague-to-colleague communication is paramount—and will require strong internal advocates willing to participate in the outreach.

So the first and potentially most important step for success: make sure internal champions are committed to expansion.


Step 2: Expand beyond the obvious LAAC patients

You want to create awareness that LAAC can benefit patients who don’t already have prior bleeds, but are at risk for bleeding. This is critical to expanding referrals.”
  Amy Schwartz, BSN, RN
Structural Heart Coordinator
CHI Health Nebraska Heart

Be aware that patients with prior bleeds are just the beginning. There are numerous patients beyond those with a history of bleeding that could benefit from LAAC. Which patients are at risk of a future bleed? Which patients are having difficulties with anticoagulants? Which patients are at risk of falls?

By expanding awareness beyond the obvious patient type, Amy and her team were able to identify a huge pool of potential patients in their community.

WATCHMAN is for which patients?

What Type of LAAC Candidates Are You Thinking About?


History of intracranial and recurrent bleeding.



No prior bleeds but high-risk HAS-BLED>CHADsVASc; include fall risk. 



An occupation with high risk of bleeding. 



Lifestyle for which anticoagulation is inappropriate.



Struggle with maintaining INR.
Discontinuation of anticoagulant medication.


Step 3: Vibrant and constant outreach

Community outreach is essential. LAAC is not top-of-mind for most healthcare professionals, so it’s important to constantly engage with clinicians and patients throughout the community.

Here are some successful ways that Amy and her team reached out to identify appropriate patients:

They identified PCPs in their community and invited them to dinner meetings, where one of the cardiologists from CHI Health Nebraska Heart gave a presentation about LAAC and what patients are appropriate.

They reached out to sister hospitals in their network and presented at their quarterly clinician education meeting.

The nurses from Amy’s program approached INR nurses about LAAC. INR nurses began sending lists of patients who had experienced falls or might benefit from getting off of blood thinners.
They organized patient education seminars and invited appropriate patients.

Amy and her team engaged the IT staff in her network to conduct an “AFib query” of their electronic health records. This helped identify a number of potential patient candidates.


Step 4: Educate patients on the benefits of LAAC

When potential patient candidates come into an LAAC program, this is not the finish line. Amy and her team have found that education is essential.

“These patients generally feel fine,” says Amy. “They’re asymptomatic, their rate is controlled, so they have no idea why you’re asking them to have a procedure done.”

Educating patients about the safety and importance of the procedure has proven valuable to increasing LAAC in appropriate patients.

It's worth the effort
Expanding an LAAC program takes hard work. It requires networking, teamwork, and persistence. But these efforts benefit your institution and the multitude of patients that can benefit from this procedure. As Amy Schwartz puts it: “This procedure puts your institution at the forefront of therapy, and you play a vital role in its success.”


Related Content

Visit these websites for more helpful information from other industry thought leaders.

WATCHMAN Webinar Series

By Boston Scientific

Dr. Shephal Doshi, EP and Dr. Robert Gillespie, Cardiologist review the clinical data and provide guidance on identifying patients who may be appropriate for LAAC.

Building a Structural Heart Practice

By Marie-France Poulin, MD; Hussam Suradi, MD; and Clifford J. Kavinsky, MD, PhD

Cardiovascular service line leaders can compare their leadership styles to the renowned Peter Drucker.



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