Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jan 13;3(1):e000335.
doi: 10.1136/openhrt-2015-000335. eCollection 2016.

Effectiveness of structured, hospital-based, nurse-led atrial fibrillation clinics: a comparison between a real-world population and a clinical trial population

Ina Qvist  1 , Jeroen M L Hendriks  2 , Dorthe S Møller  3 , Andi E Albertsen  3 , Helle M Mogensen  3 , Gitte D Oddershede  3 , Annette Odgaard  1 , Leif Spange Mortensen  4 , Søren Paaske Johnsen  5 , Lars Frost  1
Affiliations

Effectiveness of structured, hospital-based, nurse-led atrial fibrillation clinics: a comparison between a real-world population and a clinical trial population

Ina Qvist et al. Open Heart. .

Abstract

Objective: A previous randomised trial showed that structured, nurse-led atrial fibrillation (AF) care is superior to conventional AF care, although further research is needed to determine the outcomes of such care in a real-world setting. We compared the outcomes of patients in real-world, nurse-led, structured hospital AF clinics with the outcomes of a randomised trial of the efficacy of a nurse-led AF clinic, with respect to a composite outcome of cardiovascular-related hospitalisation and death.

Methods: All patients were referred to the AF nurse specialist by cardiologists. The AF nurse specialist provided patient education, risk-factor control and stimulated empowerment and compliance. During follow-up, treatment was adjusted according to clinical guidelines. Patient education was repeated, and compliance with medical treatment was controlled. The study size was powered as a non-inferiority study. Outcome measures were adjudicated by the same principles in both cohorts.

Results: A total of 596 patients from the real world and 356 patients from a clinical trial were included in this study. No significant difference between groups with respect to age, type of AF or CHA2DS2VASc score was found. The composite primary end point occurred with an incidence rate of 8.0 (95% CI 6.1 to 10.4) per 100 person-years in the real-world population and 8.3 (95% CI 6.3 to 10.9) per 100 person-years in the clinical trial, with a crude HR of 0.83 (95% CI 0.56 to 1.23).

Conclusions: Structured, nurse-led, hospital-based AF care appears to be effective, and patient outcomes in an actual, hospital-based, structured AF care are as least as good as those in trial settings.

Keywords: QUALITY OF CARE AND OUTCOMES.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Cumulative event rate of the primary outcome. The primary outcome is a composite of first occurrence of cardiovascular hospitalisation and/or cardiovascular death. RWC, real-world cohort; RCT, randomized controlled trial.
See this image and copyright information in PMC

References

    1. Gorin L, Fauchier L, Nonin E et al. . Prognosis and guideline-adherent antithrombotic treatment in patients with atrial fibrillation and atrial flutter: implications of undertreatment and overtreatment in real-life clinical practice; the Loire Valley Atrial Fibrillation Project. Chest 2011;140:911–17. 10.1378/chest.10-2436 - DOI - PubMed
    1. Kakkar AK, Mueller I, Bassand JP et al. . International longitudinal registry of patients with atrial fibrillation at risk of stroke: Global Anticoagulant Registry in the FIELD (GARFIELD). Am Heart J 2012;163:13–19. 10.1016/j.ahj.2011.09.011 - DOI - PubMed
    1. Nieuwlaat R, Olsson SB, Lip GY et al. . Guideline-adherent antithrombotic treatment is associated with improved outcomes compared with undertreatment in high-risk patients with atrial fibrillation. The Euro Heart Survey on Atrial Fibrillation. Am Heart J 2007;153:1006–12. 10.1016/j.ahj.2007.03.008 - DOI - PubMed
    1. Hess PL, Mirro MJ, Diener HC et al. . Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3–4, 2012. Am Heart J 2014;168:239–47. 10.1016/j.ahj.2014.04.007 - DOI - PMC - PubMed
    1. Hendriks JM, de WR, Crijns HJ et al. . 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. Eur Heart J 2012;33:2692–9. 10.1093/eurheartj/ehs071 - DOI - PubMed

LinkOut - more resources