TY - JOUR
T1 - Nurse-led care vs. usual care for patients with atrial fibrillation:
T2 - results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation
AU - Hendriks, Jeroen M.L.
AU - De Wit, Rianne
AU - Crijns, Harry J.G.M.
AU - Vrijhoef, Hubertus J.M.
AU - Prins, Martin H.
AU - Pisters, Ron
AU - Pison, Laurent A.F.G.
AU - Blaauw, Yuri
AU - Tieleman, Robert G.
PY - 2012/11
Y1 - 2012/11
N2 - AimsThe 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 resultsWe 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).ConclusionNurse-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.
AB - AimsThe 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 resultsWe 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).ConclusionNurse-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.
KW - Adherence to guidelines
KW - Atrial fibrillation
KW - Hospital admissions
KW - Mortality
KW - Nursing
UR - http://www.scopus.com/inward/record.url?scp=84868596026&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehs071
DO - 10.1093/eurheartj/ehs071
M3 - Article
C2 - 22453654
AN - SCOPUS:84868596026
VL - 33
SP - 2692
EP - 2699
JO - European Heart Journal
JF - European Heart Journal
SN - 0195-668X
IS - 21
ER -