Integrated nurse-led oral anticoagulation management

The management of atrial fibrillation (AF) is a complex process because AF is not only a heart rhythm disturbance but also a vascular disease, which necessitates treatment of the arrhythmia, prevention of thromboembolic complications and treatment of the underlying cardiovascular components. Moreover, although evidence-based guidelines for AF management are available, research demonstrated poor guideline adherence in the treatment of AF, resulting in increased morbidity and mortality rates in these patients. As a consequence, current practice calls for a more comprehensive management approach. This integrated approach to care contributes to the availability of evidence-based care by redesigning daily practice while improving clinical outcomes. In this paper the fundamentals of an integrated approach to care are presented in terms of a nurse-led, guideline-based, software-supported outpatient clinic for patients with AF. Also, the effectiveness of this AF-Clinic is discussed from the viewpoint of oral anticoagulation therapy, compared with usual care.