Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/94452
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Type: Journal article
Title: Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation
Author: Hendriks, J.
de Wit, R.
Crijns, H.
Vrijhoef, H.
Prins, M.
Pisters, R.
Pison, L.
Blaauw, Y.
Tieleman, R.
Citation: European Heart Journal, 2012; 33(21):2692-2699
Publisher: Published on behalf of the European Society of Cardiology
Issue Date: 2012
ISSN: 0195-668X
1522-9645
Statement of
Responsibility: 
Jeroen M.L. Hendriks, Rianne de Wit, Harry J.G.M. Crijns, Hubertus J.M. Vrijhoef, Martin H. Prins, Ron Pisters, Laurent A.F.G. Pison, Yuri Blaauw, Robert G. Tieleman
Abstract: AIMS: The management of patients with atrial fibrillation (AF) is often inadequate due to deficient adherence to the guidelines. A nurse-led AF clinic providing integrated chronic care to improve guideline adherence and activate patients in their role, may effectively reduce morbidity and mortality but such care has not been tested in a large randomized trial. Therefore, we performed a randomized clinical trial to compare the AF clinic with routine clinical care in patients with AF. METHODS AND RESULTS: We randomly assigned 712 patients with AF to nurse-led care and usual care. Nurse-led care consisted of guidelines based, software supported integrated chronic care supervised by a cardiologist. The primary endpoint was a composite of cardiovascular hospitalization and cardiovascular death. Duration of follow-up was at least 12 months. Adherence to guideline recommendations was significantly better in the nurse-led care group. After a mean of 22 months, the primary endpoint occurred in 14.3% of 356 patients of the nurse-led care group compared with 20.8% of 356 patients receiving usual care [hazard ratio: 0.65; 95% confidence interval (CI) 0.45-0.93; P= 0.017]. Cardiovascular death occurred in 1.1% in the nurse-led care vs. 3.9% in the usual care group (hazard ratio: 0.28; 95% CI: 0.09-0.85; P= 0.025). Cardiovascular hospitalization amounted (13.5 vs. 19.1%, respectively, hazard ratio: 0.66; 95% CI: 0.46-0.96, P= 0.029). CONCLUSION: Nurse-led care of patients with AF is superior to usual care provided by a cardiologist in terms of cardiovascular hospitalizations and cardiovascular mortality. Trial registration information: Clinicaltrials.gov identifier number: NCT00391872.
Keywords: Atrial Fibrillation
Mortality
Hospital admissions
Adherence to guidelines
Nursing
Description: Corrigendum: The Clinicaltrials.gov identifier number in the abstract of this article should have read NCT00753259 not NCT00391872. Please see: http://dx.doi.org/10.1093/eurheartj/ehs447
Rights: © The Author 2012. For permissions please email: journals.permissions@oup.com
DOI: 10.1093/eurheartj/ehs071
Published version: http://dx.doi.org/10.1093/eurheartj/ehs071
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