Integrated patient-centred, nurse-driven, physician-supervised AF-Clinics are associated with a reduction in all cause mortality and should be widely implemented, researchers say.
Their post-hoc analysis of a Dutch study, which randomised 712 patients to either a specialised AF clinic or usual care, found all-cause mortality rates of 3.7% versus 8.1% respectively.
The original study had reported a composite outcome of cardiovascular hospitalisation and mortality in 14.3% of patients managed in the specialised AF-clinic compared with 20.8% of those managed with usual care.
In terms of adherence to guideline recommendations, there was significantly higher compliance with thyroid function testing and better uptake of oral anticoagulation in the AF-Clinic group in the current study.
The authors, including a team from Adelaide, suggested enhanced surveillance and management of other cardiovascular conditions and risk factors, as well as the shared expertise within a collaborative multidisciplinary team versus a single healthcare professional providing usual care, may also have contributed to the reduction in all-cause mortality.
“The interventional AF-Clinic is associated with a highly significant relative risk reduction in all-cause mortality of 56%, highlighting the importance and necessity of applying an integrated, structured care approach in the management of AF,” the study authors said.
Lead investigator Dr Jeroen Hendriks told the limbic adherence to diagnostic procedures such as thyroid function testing and crucial oral anticoagulation to prevent strokes was suboptimal in the usual care group.
“Also, patients in the AF-Clinic received continuous education about e.g. AF, symptoms, treatment, but were also encouraged and empowered to undertake self-management and adhere to their treatment regimen.”
“Improved patient knowledge and the guidance on how to comply to their treatment, as well as enhanced surveillance and management of other cardiovascular conditions and risk factors, may have contributed to the observed reduction in all-cause mortality,” he said.
Features of the specialised clinics included a standardised approach to the management of AF that is then tailored to the needs and preferences of the individual patient, added Dr Hendriks.
“This means that all patients in the AF-Clinic intervention group undergo protocolised diagnostic testing. Then patients will be seen by a nurse for clinical assessment, engagement to identify their needs, and providing continuous tailored education. This process would be supervised by a cardiologist.”
“Besides patient case discussion in a multidisciplinary setting, patients received continuous follow-up at set times including continuous education and empowerment to take ownership of their condition with the aim to self-manage their condition.”
Dr Hendriks, who is affiliated with Maastricht University in the Netherlands and the Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, said redesigning the delivery of care was difficult.
“In fact, it is a different way of working with patients, and within a multidisciplinary team. Coordination of care is crucial to prevent fragmentation,” he said.
The iCARE-AF study, a multi-centre randomised controlled trial to investigate the effectiveness of integrated care in AF in Australian and New Zealand settings is about to start.