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THREE-PRONGED APPROACH IMPROVES TREATMENT RESULTS FOR IRREGULAR HEARTBEAT
Specialized Clinic, Staff and Software Ensure Guidelines are Followed
New Orleans, LA – Dutch patients treated for atrial fibrillation (AF) – the most common type of irregular heartbeat – at a specialized clinic that adheres to AF guidelines had better outcomes than patients given usual care, according to research presented today at the American College of Cardiology’s 60th Annual Scientific Session. ACC.11 is the premier cardiovascular medical meeting, bringing together cardiologists and cardiovascular specialists to further advances in cardiovascular medicine.
One in four adults over the age of 40 will eventually develop AF, making it the most common heart rhythm abnormality. In the U.S., AF affects an estimated 2.2 million people, and its prevalence is likely to rise as the population ages. Although AF is rarely a life-threatening condition, its long-term effects can lead to serious health hazards, such as blood clots and stroke. Guidelines for managing AF help reduce such risks, but a Euro Heart Survey, covering more than 5,000 patients in 35 countries, found that cardiologists often fail to follow the guidelines. In response to this finding, researchers in the Netherlands designed an AF program built around established treatment guidelines.
This study analyzed outcomes for 712 patients newly diagnosed with AF who were referred to a specialized AF Clinic or to usual care by a cardiologist in the outpatient clinic. The AF Clinic features treatment delivered by nurse specialists trained in AF, under the supervision of a cardiologist and with assistance from guidelines-based software developed for the study. At the clinic, detailed medical information about patients is fed into a database, where it is used to create individual risk profiles. The software then provides a treatment plan based on AF guidelines and oral anticoagulation therapy to prevent blood clots. As part of this process, the nurses focus on patient education on AF, treatment and general healthier lifestyle information, and clinic staff coordinate care with the referring general practitioner.
“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,” said Jeroen M. Hendriks, MSc, Maastricht University Medical Centre, Maastricht, the Netherlands, an investigator and lead author for the study. “The specialized AF Clinic helps in closing the gap between guideline recommendations and current clinical practice.”
At the start of the study, cardiovascular conditions represented among patients in the AF Clinic’s nurse-led care (NLC) group and usual-care (UC) group included hypertension (187 NLC vs. 193 UC), stroke (44 NLC vs. 45 UC), coronary artery disease (33 NLC vs. 38 UC) and heart failure (25 NLC vs. 25 UC). 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.
After a mean follow-up of 22 months, 125 patients had reached the primary endpoint: 51 (14.3 percent) in the AF Clinic group and 74 (20.8 percent) in the usual care group. Deaths and hospitalizations were significantly lower among patients treated at the AF Clinic: deaths, 4 (1.1 percent) vs. 14 (3.9 percent), and hospitalizations, 48 (13.5 percent) vs. 68 (19.1 percent).
“Effective AF management can enhance appropriate treatment, coordinate the delivery of care more efficiently and bring improved outcomes, as we showed in this trial,” said principal investigator Robert G. Tieleman, M.D., Martini Hospital, Groningen, the Netherlands. “We can’t pinpoint the nurses or guidelines or software as the sole reason for our results. I think the secret is the integrated approach – the combination of these three ingredients.”
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.
Dr. Hendriks will be available to the media on Tuesday, April 5, at 12:30 p.m. CDT, in Room 338/339.
Dr. Hendriks and Dr. Tieleman will jointly present the study, “Specialized Atrial Fibrillation Clinic Reduces Cardiovascular Morbidity and Mortality in Patients with Atrial Fibrillation,” on Tuesday, April 5, at 10:45 a.m. CDT, in the Joint Main Tent: La Nouvelle.
The American College of Cardiology (www.cardiosource.org) represents the majority of board certified cardiovascular care professionals through education, research, promotion, development and application of standards and guidelines – and to influence health care policy. ACC.11 is the largest cardiovascular meeting, bringing together cardiologists and cardiovascular specialists to share the newest discoveries in treatment and prevention, while helping the ACC achieve its mission to address and improve issues in cardiovascular medicine.