The effect of a nurse-led integrated chronic care approach on quality of life in patients with atrial fibrillation

Abstract

Aims: Quality of life (QoL) is often impaired in patients with atrial fibrillation (AF). A novel nurse-led integrated chronic care approach demonstrated superiority compared with usual care in terms of cardiovascular hospitalization and mortality. Consequently, we hypothesized that this approach may also improve QoL and AF-related knowledge, which in turn may positively correlate with QoL.

Methods and results: In this randomized controlled trial, 712 patients were randomly assigned to nurse-led care vs. usual care. Nurse-led care consisted of guidelines-based, software supported care, supervised by cardiologists. Usual care was provided by cardiologists in the regular outpatient setting. Quality of life was assessed by means of the Medical Outcomes Study 36-Item Short-Form Survey (SF-36). The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression scores. The AF knowledge scale was used to gain an insight into the patients' AF knowledge levels. Baseline QoL scores were relatively high in both groups, with median scores ranging from 55 to 100. Quality of life significantly improved over time in both groups with no significant differences between the two groups. Atrial fibrillation-related knowledge improved over time and was significantly higher at follow-up in the intervention group, compared with the usual care group (8.23 ± 2.16 vs. 7.66 ± 2.09; P < 0.05). Quality of life was correlated with gender (rs: -5.819 to -2.960), anxiety (rs: -0.746 to -0.277), depression (rs: -0.596 to -0.395), and knowledge (rs: 0.145-0.245), expressed in Spearman's rank correlation coefficient (rs).

Conclusion: Quality of life including anxiety and depression improved over time, regardless of the treatment group. The AF-related knowledge level was better in the nurse-led care group at follow-up. Trial registration information: Clinicaltrials.gov identifier number: NCT00753259.

Keywords: Anxiety and depression; Atrial fibrillation; Nurse-led care; Patient knowledge; Quality of life.