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Type: Journal article
Title: Integrated specialized atrial fibrillation clinics reduce all-cause mortality: post hoc analysis of a randomized clinical trial
Author: Hendriks, J.M.L.
Tieleman, R.G.
Vrijhoef, H.J.M.
Wijtvliet, P.
Gallagher, C.
Prins, M.H.
Sanders, P.
Crijns, H.J.G.M.
Citation: Europace, 2019; 21(12):1785-1792
Publisher: Oxford University Press (OUP)
Issue Date: 2019
ISSN: 1099-5129
Statement of
Jeroen M L Hendriks, Robert G Tieleman, Hubertus J M Vrijhoef, Petra Wijtvliet, Celine Gallagher, Martin H Prins, Prashanthan Sanders, Harry J G M Crijns
Abstract: 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 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). 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.
Keywords: Atrial fibrillation
Integrated care
Multidisciplinary teams
Nurse co-ordination
Rights: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( Supplementary data
DOI: 10.1093/europace/euz209
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