Format

Send to

Choose Destination
Europace. 2019 Aug 7. pii: euz209. doi: 10.1093/europace/euz209. [Epub ahead of print]

Integrated specialized atrial fibrillation clinics reduce all-cause mortality: post hoc analysis of a randomized clinical trial.

Author information

1
Department of Cardiology, Maastricht University Medical Centre+, and Cardiovascular Research Institute Maastricht (CARIM), 6202 AZ, Maastricht, The Netherlands.
2
Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
3
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
4
Department of Cardiology, Martini Hospital Groningen, Groningen, The Netherlands.
5
Department Patient and Care, Maastricht University Medical Centre+, Maastricht, The Netherlands.
6
Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium.
7
Panaxea b.v., Amsterdam, The Netherlands.
8
Department of Epidemiology, Maastricht University Medical Centre+, Maastricht, The Netherlands.

Abstract

AIMS:

An integrated chronic care programme in terms of a specialized outpatient clinic for patients with atrial fibrillation (AF), has demonstrated improved clinical outcomes. The aim of this study is to assess all-cause mortality in patients in whom AF management was delivered through a specialized outpatient clinic offering an integrated chronic care programme.

METHODS AND RESULTS:

Post hoc analysis of a Prospective Randomized Open Blinded Endpoint Clinical trial to assess all-cause mortality in AF patients. The study included 712 patients with newly diagnosed AF, who were referred for AF management to the outpatient service of a University hospital. In the specialized outpatient clinic (AF-Clinic), comprehensive, multidisciplinary, and patient-centred AF care was provided, i.e. nurse-driven, physician supervised AF treatment guided by software based on the latest guidelines. The control group received usual care by a cardiologist in the regular outpatient setting.After a mean follow-up of 22 months, all-cause mortality amounted 3.7% (13 patients) in the AF-Clinic arm and 8.1% (29 patients) in usual care [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.23-0.85; P = 0.014]. This included cardiovascular mortality in 4 AF-Clinic patients (1.1%) and 14 patients (3.9%) in usual care (HR 0.28; 95% CI 0.09-0.85; P = 0.025). Further, 9 patients (2.5%) died in the AF-Clinic arm due to a non-cardiovascular reason and 15 patients (4.2%) in the usual care arm (HR 0.59; 95% CI 0.26-1.34; P = 0.206).

CONCLUSION:

An integrated specialized AF-Clinic reduces all-cause mortality compared with usual care. These findings provide compelling evidence that an integrated approach should be widely implemented in AF management.

KEYWORDS:

Atrial fibrillation; Integrated care; Mortality; Multidisciplinary teams; Nurse co-ordination

PMID:
31390464
DOI:
10.1093/europace/euz209

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center