Nurse-Led Care vs. Usual Care for Patients With Atrial Fibrillation: Results of a Randomized Trial of Integrated Chronic Care vs. Routine Clinical Care in Ambulatory Patients With Atrial Fibrillation

Study Questions:

Does nurse-led care improve outcomes in patients with atrial fibrillation (AF)?

Methods:

Outpatients with AF were randomly assigned to nurse-led care (n = 356, mean age 66 years) or usual care by a cardiologist (n = 356, mean age 67 years). Nurse-led care was guided by decision support software based on guidelines and was supervised by a cardiologist. Follow-up visits were scheduled at 3 and 6 months and at 6-month intervals thereafter. The primary outcome was a composite of cardiovascular death and cardiovascular hospitalization.

Results:

Stroke-prevention therapy was consistent with guidelines more often in the nurse-led group (99%) than in the usual care group (83%). During a mean follow-up of 22 months, the primary outcome occurred significantly more often in the usual care group (20.8%) than in the nurse-led group (14.3%). The cardiovascular death and hospitalization rates were significantly lower in the nurse-led group than in the usual care group (1.1 and 13.5% vs. 3.9 and 19.1%, respectively).

Conclusions:

The authors concluded that nurse-led care improves outcomes in outpatients with AF.

Perspective:

The results are disconcerting because they demonstrate that conventional care of patients with AF by cardiologists is associated with higher rates of cardiovascular mortality and hospitalization than nurse-led care. It is likely that a major reason for the improved outcomes in the nurse-led group was better adherence to guidelines. This suggests a strong need for better education on guidelines in the cardiology community.

Keywords: Long-Term Care, Nurses, Hospitalization


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