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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.

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



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.


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).


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.


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


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