TY - JOUR
T1 - Integrated specialized atrial fibrillation clinics reduce all-cause mortality
T2 - post hoc analysis of a randomized clinical trial
AU - Hendriks, Jeroen M. L.
AU - Tieleman, Robert G.
AU - Vrijhoef, Hubertus J. M.
AU - Wijtvliet, Petra
AU - Gallagher, Celine
AU - Prins, Martin H.
AU - Sanders, Prashanthan
AU - Crijns, Harry J. G. M.
N1 - Funding Information:
J.M.L.H. was supported by a Future Leader Fellowship from the Australian Heart Foundation and the Derek Frewin Lectureship from the University of Adelaide. C.G. was supported by the Leo Mahar Cardiovascular Nursing Scholarship from the University of Adelaide. P.S. was supported by a Practitioner Fellowship from the National Health and Medical Research Council (NHMRC) and National Heart Foundation of Australia. H.J.G.M.C. was supported by the Netherlands Heart Foundation, CVON 2014-9: Reappraisal of Atrial Fibrillation: interaction between hyperCoagulability, Electrical remodelling, and Vascular destabilization in the progression of AF (RACE V). The trial was supported by the University Hospital Maastricht as well as by unrestricted educational grants from Boehringer Ingelheim and Medtronic Bakken Research Centre. The sponsors were not in any way involved in the study. The remaining authors have nothing to declare.
Funding Information:
Conflict of interest: J.M.L.H. reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Medtronic and Pfizer/BMS. P.S. reports having served on the advisory board of Biosense-Webster, Medtronic, St Jude Medical, Boston Scientific and CathRx. P.S. reports that the University of Adelaide has received on his behalf lecture and/or consulting fees from Biosense-Webster, Medtronic, St Jude Medical, and Boston Scientific. P.S. reports that the University of Adelaide has received on his behalf research funding from Medtronic, St Jude Medical, Boston Scientific, Biotronik, and LivaNova. H.J.G.M.C. reports that the Maastricht University Medical Centre received on his behalf research funding from Medtronic, AtriCure, Boehringer Ingelheim, Bayer, Bristol Myers Squib, Pfizer, and Daiichi-Sankyo. All other authors have no conflict of interest to declare.
Publisher Copyright:
© 2019 Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
PY - 2019/12
Y1 - 2019/12
N2 - 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.
AB - 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.
KW - Atrial fibrillation
KW - Integrated care
KW - Mortality
KW - Multidisciplinary teams
KW - Nurse co-ordination
KW - MANAGEMENT
KW - RISK
KW - GUIDELINES
KW - OUTCOMES
KW - CARE
U2 - 10.1093/europace/euz209
DO - 10.1093/europace/euz209
M3 - Article
C2 - 31390464
SN - 1099-5129
VL - 21
SP - 1785
EP - 1792
JO - EP Europace
JF - EP Europace
IS - 12
ER -