Integrated specialized atrial fibrillation clinics reduce all-cause mortality: post hoc analysis of a randomized clinical trial

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dc.contributor.authorHendriks, J.M.L.
dc.contributor.authorTieleman, R.G.
dc.contributor.authorVrijhoef, H.J.M.
dc.contributor.authorWijtvliet, P.
dc.contributor.authorGallagher, C.
dc.contributor.authorPrins, M.H.
dc.contributor.authorSanders, P.
dc.contributor.authorCrijns, H.J.G.M.
dc.date.issued2019
dc.description.abstractAIMS: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.
dc.description.statementofresponsibilityJeroen M L Hendriks, Robert G Tieleman, Hubertus J M Vrijhoef, Petra Wijtvliet, Celine Gallagher, Martin H Prins, Prashanthan Sanders, Harry J G M Crijns
dc.identifier.citationEuropace, 2019; 21(12):1785-1792
dc.identifier.doi10.1093/europace/euz209
dc.identifier.issn1099-5129
dc.identifier.issn1532-2092
dc.identifier.orcidHendriks, J.M.L. [0000-0003-4326-9256]
dc.identifier.orcidGallagher, C. [0000-0002-5114-400X]
dc.identifier.orcidSanders, P. [0000-0003-3803-8429]
dc.identifier.urihttp://hdl.handle.net/2440/123262
dc.language.isoen
dc.publisherOxford University Press (OUP)
dc.rightsPublished on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Supplementary data
dc.source.urihttps://doi.org/10.1093/europace/euz209
dc.subjectAtrial fibrillation
dc.subjectIntegrated care
dc.subjectMortality
dc.subjectMultidisciplinary teams
dc.subjectNurse co-ordination
dc.titleIntegrated specialized atrial fibrillation clinics reduce all-cause mortality: post hoc analysis of a randomized clinical trial
dc.typeJournal article
pubs.publication-statusPublished

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