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Integrated specialized atrial fibrillation clinics reduce all-cause mortality: post hoc analysis of a randomized clinical trial
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Maastricht Univ, Netherlands; Univ Adelaide, Australia; Royal Adelaide Hosp, Australia.
Martini Hosp Groningen, Netherlands.
Maastricht Univ, Netherlands; Vrije Univ Brussel, Belgium; Panaxea Bv, Netherlands.
Maastricht Univ, Netherlands; Martini Hosp Groningen, Netherlands.
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2019 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 21, no 12, p. 1785-1792Article in journal (Refereed) Published
Abstract [en]

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 22months, 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.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS , 2019. Vol. 21, no 12, p. 1785-1792
Keywords [en]
Atrial fibrillation; Integrated care; Mortality; Multidisciplinary teams; Nurse co-ordination
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-163380DOI: 10.1093/europace/euz209ISI: 000506802500007PubMedID: 31390464OAI: oai:DiVA.org:liu-163380DiVA, id: diva2:1391055
Note

Funding Agencies|Future Leader Fellowship from the Australian Heart Foundation; Derek Frewin Lectureship from the University of Adelaide; Leo Mahar Cardiovascular Nursing Scholarship from the University of Adelaide; Practitioner Fellowship from the National Health and Medical Research Council (NHMRC)National Health and Medical Research Council of Australia; National Heart Foundation of AustraliaNational Heart Foundation of Australia; Netherlands Heart FoundationNetherlands Heart Foundation [CVON 2014-9]; University Hospital Maastricht; Boehringer IngelheimBoehringer Ingelheim; Medtronic Bakken Research Centre

Available from: 2020-02-03 Created: 2020-02-03 Last updated: 2020-02-03

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