Clinical management of atrial fibrillation: early interventions, observation, and structured follow-up reduce hospitalizations

Abstract

Background: Novel facilities such as an intensive observation unit and an outpatient clinic could result in improving management of patients presenting with atrial fibrillation (AF). Methods: This observational study enrolled 3475 patients. Group 1 (1120 patients; years [2004][2005] was managed with standard approach; group 2 (992 patients; years [2006][2007] was managed with additional intensive observation; group 3 (1363 patients; years 2008-2009) was managed with additional intensive observation and outpatient clinic. Primary end point was admission to hospital. Secondary end points included modalities of rhythm conversion and administration of class IC vs class III antiarrhythmic drugs in patients with AF lasting less than 48 hours. Results: Lack of rhythm control, comorbidities, diabetes, and age were independent predictors of hospitalization. Admissions significantly decreased from group 1 (50%) to 2 (38%) and to 3 (24%) (P b .001). Interestingly, more than a quarter of patients in group 3 were referred to the outpatient clinic for short-term follow-up, eventually avoiding admission. Patients with AF lasting less than 48 hours (n = 2189) and without structural heart disease (n = 1685) achieved sinus rhythm in 89% of cases and were discharged. In these patients, early administration of antiarrhythmic drugs of class IC and III gained sinus rhythm in 80% and 20%, respectively (P b .001). Spontaneous conversion occurred in 26%; electrical, 17%; and pharmacological, 57%. Conclusions: In patients with AF, beyond the standard approach, the novel organization with an additional intensive observation unit for early pharmacological interventions and an outpatient clinic for elective treatment and short-term follow-up significantly reduced admission irrespective of independent predictors of hospitalizations. Patients without structural heart disease treated with antiarrhythmic drugs achieved sinus rhythm in 89% of cases, mostly with class IC drugs.

Promoting a sense of security in everyday life—A case study of patients and professionals moving towards co‐production in an atrial fibrillation “learning café”

“…This indicates that facilitating coping strategies might reduce patients' demand for emergency care. This aligns with research suggesting that patient support, one of the components of integrated AF care, can reduce the demand for emergency care among patients with AF …”

“…Persons with a good understanding of their AF report fewer symptoms and fewer AF‐related negative emotions . Although various structured approaches to AF care have been tried worldwide, it is still unclear what design to use in different health‐care settings for integrated AF care, including patient support and education . A key design idea in such support initiatives is to enable fruitful interactions between fellow persons living with the same condition, family members and health‐care professionals.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…W australijskiej RCT wykazano jednak tylko marginalny wpływ na zgony i nieplanowane hospitalizacje, gdy stosowano zintegrowaną opiekę ograniczoną do początkowego okresu leczenia, co być może podkreśla potrzebę długotrwałej integracji leczenia AF [332]. W 2 badaniach obserwacyjnych dotyczących zintegrowanego leczenia AF stwierdzono mniejszą częstość hospitalizacji [333,334], w 1 badaniu zaobserwowano mniej przypadków udaru mózgu [333], a w kolejnym nierandomizowanym badaniu wykazano trend w kierunku mniejszej częstości występowania złożonego punktu końcowego obejmującego zgony, hospitalizacje z przyczyn sercowo--naczyniowych oraz wizyty na oddziale pomocy doraźnej związane z AF [335]. Potrzeba większej liczby badań na ten temat, a zintegrowana opieka nad pacjentami z AF będzie prawdopodobnie wymagać różnych schematów postępowa-nia w różnych warunkach funkcjonowania opieki zdrowotnej.…”

Management of newly diagnosed atrial fibrillation in an outpatient clinic setting—patient's perspectives and experiences

“…An intervention to contribute to reducing hospitalisation significantly in these patients is to strengthen outpatient services for elective treatment and short‐term follow‐up (Conti et al., ). A nurse‐coordinated outpatient clinic might contribute to this in terms of reducing waiting times and number of appointments, improving patients’ experiences of arrhythmia services and reducing healthcare costs (Wise & Annus, ).…”