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

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

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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.

Original languageEnglish
Pages (from-to)1785-1792
Number of pages8
JournalEUROPACE
Volume21
Issue number12
DOIs
Publication statusPublished - 1 Dec 2019
Externally publishedYes

Keywords

  • Atrial fibrillation
  • Integrated care
  • Mortality
  • Multidisciplinary teams
  • Nurse co-ordination

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    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. (2019). Integrated specialized atrial fibrillation clinics reduce all-cause mortality: Post hoc analysis of a randomized clinical trial. EUROPACE, 21(12), 1785-1792. https://doi.org/10.1093/europace/euz209