The Atrial Fibrillation Clinic Experience: Lessons From HonorHealth’s Clinic Model

Interview With Amy Kleinhans DNP, FHRS

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Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of EP Lab Digest or HMP Global, their employees, and affiliates. 

Edited by Jodie Elrod

EP Lab Digest talks with Amy Kleinhans DNP, FHRS, about her presentation entitled "The AF Clinic Experience” at Western AFib 2026.

Can you start by introducing yourself?

My name is Amy Kleinhans. I'm a nurse practitioner who works in the cardiac arrhythmia group at HonorHealth, which is a hospital system in the greater Phoenix/Scottsdale area. We currently have 8 electrophysiologists and 8 nurse practitioners. We service 8 hospitals and have about 45 cardiologists. 

What specific services and care pathways define HonorHealth’s Atrial Fibrillation (AFib) Clinic, and how does it address gaps that often exist in traditional AFib management?

It was around 2019, about the same time HRS released their white paper on comprehensive AFib centers of excellence. One of the biggest gaps we identified in AFib care is the variability in anticoagulation strategies. Even today, we still see patients who are underdosed or on supra- or subtherapeutic doses. The estimate remains that about 40% of patients who should be on anticoagulation aren’t on it at all.

From an EP standpoint, cardiology has historically acted as the gatekeeper for AFib referrals. Often, by the time patients reach us, their disease—once subclinical—has already progressed. It may not have been detected until it became persistent or even longstanding persistent AFib. At that point, patients may present with heart failure and significant day-to-day limitations. When they finally come to us, their atria are enlarged, and rhythm control becomes much more complex due to that delay. Those early, subtle signs of AFib progression often go unnoticed, and that delay has real consequences.

Another major issue is risk factor modification—no one truly owns it. EP assumes primary care is addressing it, while primary care assumes cardiology is managing it. Meanwhile, time constraints make it difficult for anyone to fully take it on. A 15- or 20-minute visit is considered substantial, but many physicians are seeing patients in just 10 to 15 minutes. Advanced practice providers (APPs) may have slightly longer visits, around 20 minutes, but these are complex patients with multiple comorbidities who require more time than that. 

As a result, the pieces that often get lost—especially when significant patient education is required—are related to lifestyle. Conversations about alcohol use, smoking, sleep, diet, weight, and the sustainability of staying on anticoagulation therapy don’t consistently happen. Each of these areas requires time and individualized coaching, and without clear ownership, they are frequently overlooked.

With the introduction of AFib management guidelines outlining four pillars, including lifestyle modification, it became clear that we needed to take ownership. The question then became how EP would deliver on that expectation as part of our guidelines. We recognized the need to build a comprehensive clinic structure that allows for the necessary time, resources, and level of monitoring—enabling us to identify disease progression, establish clear escalation pathways to EPs when needed, and take ownership of lifestyle interventions, including creating referral pathways to bariatrics, sleep medicine, and other subspecialties.

That was the central challenge when we set out to build an EP program at HonorHealth. We didn’t want to provide episodic care, which has traditionally defined AFib management. Instead, we aimed for longitudinal care. AFib isn’t something we cure—it’s something we manage over time. Our goal was to create a one-stop shop where patients could receive continuous, comprehensive care for the rest of their lives.

What practical take-home lessons should attendees at Western AFib be able to apply in their own programs or practices?

I feel like you could almost have an entire conference just on how to build an AFib clinic—it could really be its own topic. But in a conference presentation, you have a limited window of time, so I try to focus on what attendees can realistically take away. I could walk through our full backstory—our history, successes, and failures—but what I really want is to speak to those who are considering building an AFib clinic and feel like it may be too much, or that it requires a huge upfront investment. The reality is that most successful AFib clinics aren’t launched all at once—they evolve over time. It’s more of an iterative process. You start with small wins and then expand to the next site. We began our AFib clinic as a pilot at one hospital. Once we saw it was working, we expanded to 3 more hospitals. After that proved successful, we scaled it across the system and made it a system-wide initiative. That was how we did it.

What I want to convey to the audience is that, in the beginning, it might just be you and a physician—or you and a nurse practitioner—getting the initiative off the ground. I want to give them concrete, actionable steps they can use to achieve early wins.

I also plan to talk about what I would have done differently if I could go back. When I started this clinic, I thought it would be an immediate success and that everyone would buy into the vision because it made so much sense. That wasn’t the case. I encountered roadblock after roadblock, meeting after meeting, barrier after barrier. Each time something new came up, we had to pivot and adjust.

What our AFib clinic looks like today isn’t exactly what I originally envisioned—it’s a bit different. In some ways, it’s even better than I expected; in other areas, we still have room to grow and barriers to overcome. There’s that saying—a journey starts with a single step—and that’s really the message I want to leave them with. My goal is to offer clear, practical guidance on what I would do if I were starting from scratch.

You don’t have to be a large center. You don’t need 16 providers across 8 hospitals in 3 cities to launch an AFib program. You need one physician, one NP (if available), and a few strong pathways and protocols. If you build that structure, you can do this too.

What are some of the biggest challenges in AFib management today, and how do you see comprehensive, clinic-based models like HonorHealth’s creating new opportunities to improve outcomes and care coordination?

The main challenge with AFib is its impact on an aging population. Even with all the known risk factors, it remains an arrhythmia of aging. We see case volumes grow exponentially as patients get older, with more octogenarians presenting in our labs. With that aging population comes a higher burden of comorbidities. At the same time, many of the challenges in AFib care today are the same ones we’ve always faced—underutilization of anticoagulation, subtherapeutic or supratherapeutic dosing, and siloed care. There’s often a mindset of, “That’s not my box, so I’m not going to step into it.” For example, when I see a patient in clinic, I may adjust their heart failure medications, then reach out to their cardiologist to let them know what I’ve done so they can resume management.

But that approach reflects a broader issue in healthcare. Cardiology isn’t a single entity—it includes structural heart, heart failure, interventional cardiology, and EP. With so many subspecialties, it’s difficult to stay current outside your own area. I know what’s new in EP, but not necessarily what’s new in structural or interventional cardiology. As a result, care tends to remain siloed, and communication becomes challenging. We’re fortunate at HonorHealth because we employ our own physician group and share a common electronic health record (EHR). That allows me to step into another provider’s “sandbox” and send a quick Epic message—for example, letting them know I doubled a patient’s torsemide because they’re back in AFib and planning a cardioversion. That level of coordination is much harder when working with outside cardiologists referred into the AFib clinic—it requires extra steps and time. When EHRs aren’t shared, care becomes fragmented, and it’s difficult to both send and receive timely information.

In Phoenix, where there are multiple health systems—HonorHealth, CommonSpirit, and Banner—patients may receive care across different networks. A patient who follows with me might live closer to a Banner hospital and end up in a Banner emergency department (ED).

Given all these challenges—an aging population, increasing comorbidities, and multiple providers working across different systems and EHRs—a comprehensive AFib center helps bring everything into a clear structure of ownership. When patients come into our AFib clinic, we take responsibility for their longitudinal care. We intentionally allow more time for visits—for example, new patients are scheduled for 2 time slots instead of 1, so a 20-minute slot becomes 40 minutes. That additional time is critical for education.

I also find that many patients misunderstand AFib. They often think it can be cured, when in reality it’s something we manage over time. We set that expectation early, explaining that while we can manage AFib effectively, it’s not realistic to expect a completely AFib-free life. Breakthrough episodes will happen, and we work with patients on how to manage them.

We’ve also incorporated newer technologies, including data management software that allows us to monitor patients through devices like the Apple Watch. Many patients already have access to commercially available devices—they purchase them, educate themselves, and even use tools like ChatGPT. This allows us to extend care beyond in-person visits, procedures, and follow-ups, using remote monitoring to support patients as they go about their daily lives. AFib tends to occur at the most inconvenient times—sometimes we understand why, and sometimes we don’t—but patients know we have a plan in place. They can call the clinic, and we maintain urgent add-on slots 5 days a week. We want to avoid unnecessary ED visits, because in most cases, they aren’t needed. Instead, patients can be seen in our clinic within 72 hours.

We also have an AFib nurse navigator who follows up with patients and provides guidance on medication adjustments. There are many ways to manage AFib without defaulting to the ED for palpitations. Otherwise, care becomes siloed again, and patients may be admitted for issues we could have managed in the outpatient setting. By keeping care coordinated within our clinic, patients stay connected to us—they know we’re there and that we’ll support them when AFib recurs. That has been incredibly helpful.

Ultimately, I think this approach improves patients’ quality of life. It gives them a clearer understanding of their condition and sets realistic expectations—almost a reset moment of, “This is what it is, but we’ve got it, and we can take care of it.”

The transcripts were edited for clarity and length.