The incidence and prevalence of atrial fibrillation (AF) is increasing as the population ages, and people live longer with conditions such as hypertension and heart disease that can lead to AF. Managing AF and ensuring appropriate evidence-based treatment, especially anti-coagulation to prevent strokes, is essential but not always consistently done despite ESC guidelines on AF.
A randomised clinical trial in the Netherlands to compare treatment in a specialised AF clinic with usual care by cardiologists was recently completed and results presented at the American College of Cardiology Congress in April. The AF clinic included nurse specialists with cardiologist supervision and guidelines-based software that provide treatment plans. The nurses were able to empower patients through spending time on patient education including diagnostic tests, treatment options, symptom management, complications and needed lifestyle changes. The nurses also coordinated care with referring practitioners. The primary endpoint was a composite of: death from cardiovascular causes and cardiovascular hospitalization for heart failure; stroke from a blocked artery to the brain (ischemic stroke); acute heart attack (myocardial infarction); systemic embolism; major bleeding; defined arrhythmic events; and life-threatening adverse effects of drugs. As reported in the ACC* press release, CCNAP member Jeroen Hendriks, MSc, Maastricht University Medical Centre, Maastricht, the Netherlands, an investigator and lead author for the study said: “The system guides nurses and cardiologists through the entire process of integrated chronic care to ensure they don’t miss anything in diagnostics or therapeutics. The specialized AF Clinic helps in closing the gap between guideline recommendations and current clinical practice.” After a mean follow-up of 22 months for 712 randomised patients, the results showed a reduction in the composite primary endpoint for the AF clinic group (14.3% vs 20.8%). Deaths and hospitalizations were significantly lower among patients treated at the AF Clinic: deaths, 1.1% vs. 3.9 %, and hospitalizations, 13.5% vs. 19.1%.
The integrated, guidelines-based approach was successful in improving patient outcomes. The AF Clinic is now part of the official outpatient clinic at the university hospital. Many other hospitals in the Netherlands are setting up AF Clinics with help from the Maastricht team, and the Dutch Society of Cardiovascular Nursing is starting a working group for nurses on how to develop and evaluate an AF Clinic. * American College of Cardiology
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