Integrated Care in Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice with an epidemiological coupling appreciated with advancing age, cardiometabolic risk factors, and structural heart disease. This has resulted in a significant public health burden over the years, evident through increasing rates of hospitalization and AF-related clinical encounters. The resultant gap in health care outcomes is largely twinned with suboptimal rates of anticoagulation prescription and adherence, deficits in symptom identification and management, and insufficient comorbid cardiovascular risk factor investigation and modification. In view of these shortfalls in care, the establishment of integrated chronic care models serves as a road map to best clinical practice. The expansion of integrated chronic care programs, which include multidisciplinary team care, nurse-led AF clinics, and use of telemedicine, are expected to improve AF-related outcomes in the coming years. This review will delve into current gaps in AF care and the role of integrated chronic care models in bridging fragmentations in its management.

Optimizing adherence and persistence to non-vitamin K antagonist oral anticoagulant therapy in atrial fibrillation

“…Physicians often overestimate bleeding risk, and this apprehension about feeling responsible for a major bleed seems to outweigh their concern about risk of stroke. 14 , 51–53 A study using warfarin identified a previous major bleed as a limiting factor for OAC prescription, although prescription was not influenced by the occurrence of an ischaemic stroke in an untreated AF patient. 54 …”

“…Despite the intuitive potential benefit of educational interventions and clinical decision tools, currently there is little robust evidence, 51 , 53 , 76 sometimes even with contradictory findings. 53 , 77 , 78 However, regular scheduled contact with healthcare professionals, patient anticoagulation card recordings, and an active multidisciplinary approach have been proposed to improve patient’s adherence.…”

“…The use of Mobile Health technology (mHealth) in the management of AF has been shown to improve patient quality of life, knowledge, anticoagulation satisfaction, drug adherence and persistence, and clinical outcomes. 51 , 91–94 These mobile AF applications incorporate inbuilt personal health records, clinical decision support tools, and education programmes in keeping with integrated care principles. 51 , 92–94 Further studies on the applicability of these technological advancements in healthcare systems and integrated care are needed.…”

“… 51 , 91–94 These mobile AF applications incorporate inbuilt personal health records, clinical decision support tools, and education programmes in keeping with integrated care principles. 51 , 92–94 Further studies on the applicability of these technological advancements in healthcare systems and integrated care are needed. 51 , 91 …”

“… 51 , 92–94 Further studies on the applicability of these technological advancements in healthcare systems and integrated care are needed. 51 , 91 …”