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
Does nurse-led care improve outcomes in patients with atrial fibrillation (AF)?
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.
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).
The authors concluded that nurse-led care improves outcomes in outpatients with AF.
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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