Standard Versus Atrial Fibrillation-Specific Management Strategy (SAFETY) to Reduce Recurrent Admission and Prolong Survival: Pragmatic, Multicentre, Randomised Controlled Trial

Study Questions:

What is the clinical value of a nurse-led, home-based management strategy for patients with atrial fibrillation (AF)?

Methods:

Three hundred thirty-five patients (mean age 72 years) hospitalized for paroxysmal or persistent AF were randomly assigned to standard management (n = 167) or the study intervention (n = 168)—a home visit and Holter monitoring 1-2 weeks post-hospital discharge and multidisciplinary support as needed during follow-up. All patients were followed for ≥24 months (median 30.2 months). The primary outcome was all-cause mortality or unplanned hospital readmission.

Results:

A clinical issue that prompted an intervention was present in 63% of patients in the study group at the time of the first home visit 1-2 weeks post-discharge. The most common interventions were education sessions, regular telephone support, and repeat home visits. Holter monitoring demonstrated an uncontrolled heart rate in 26% of patients in the study group. The primary outcome of death or unplanned hospitalizations did not differ significantly between the study group (76%) and the control group (82%). An event-free day was significantly more frequent in the study group (96% of days) than in the control group (91.8% of days).

Conclusions:

The authors concluded that a post-discharge, nurse-led, home-based management strategy specific to AF results in a larger number of days free of hospitalization or death.

Perspective:

The significantly higher proportion of event-free days during follow-up in the study group was driven by fewer days of hospitalization. The nurse-led AF management strategy used in this study could have resulted in fewer days of hospitalization for several reasons, including early recognition and treatment of an uncontrolled rate, better patient compliance, and early intervention for under- or over-anticoagulation.

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Early Intervention (Education), Follow-Up Studies, House Calls, Patient Readmission, Telephone, Atrial Fibrillation, Electrocardiography, Ambulatory, Heart Rate, Patient Discharge, Hospitalization, Patient Compliance, AHA Annual Scientific Sessions


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