Does a nurse-led interventional program improve clinical outcomes in patients with atrial fibrillation? A meta-analysis

Abstract

Background Being the most common type of arrhythmia, atrial fibrillation (AF) is progressively increasing with an annual rate of 5 million new cases. Recent guidelines highlight the importance of using collaborative multidisciplinary teams in order to improve outcomes during management of patients with AF. A nurse-led program including a nurse-directed education, counselling and intervention has shown to improve patients’ outcomes in candidates with AF. In this analysis, we aimed to systematically compare the clinical outcomes observed in patients with AF who were assigned to a nurse-led interventional program versus a usual care group. Methods EMBASE, MEDLINE, Http://www.ClinicalTrials.gov, Web of Science; Google Scholar and Cochrane databases were the data sources. The clinical outcomes were considered as the endpoints in this study. This is a meta-analysis, and the statistical analysis was conducted by the RevMan software (version 5.4). Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the data after statistical analysis. Results Six studies with a total number 2916 participants were included whereby 1434 participants were assigned to a nurse-led intervention and 1482 participants were assigned to the usual care group. Our results showed that participants with AF who were assigned to the nurse-led interventional group had a significantly lower risk of composite endpoints (RR: 0.82, 95% CI: 0.70–0.96; P = 0.01), heart failure (RR: 0.66, 95% CI: 0.47–0.92; P = 0.02), atrial fibrillation (RR: 0.77, 95% CI: 0.63–0.94; P = 0.01) and re-admission (RR: 0.78, 95% CI: 0.62–0.99; P = 0.04). However, the risks of all-cause mortality (RR: 0.86, 95% CI: 0.68–1.09; P = 0.21), cardiac death (RR: 0.67, 95% CI: 0.33–1.39; P = 0.28), myocardial infarction (RR: 0.70, 95% CI: 0.35–1.42; P = 0.33), stroke (RR: 0.75, 95% CI: 0.44–1.26; P = 0.28), all bleeding events (RR: 1.11, 95% CI: 0.81–1.53; P = 0.51) and major bleeding events (RR: 0.91, 95% CI: 0.56–1.49; P = 0.71) were not significantly different. Conclusions The nurse-led interventional program significantly improved composite endpoints including heart failure and the recurrence of AF, resulting in a significantly lower admission rate compared to the usual care group. However, nurse-led interventional program did not affect mortality, stroke, myocardial infarction and bleeding events. Based on our current results, a nurse-led interventional programs apparently could be beneficial in patients with AF. Future larger trials would be able to confirm this hypothesis.