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. 2016 Dec 31;9(4):1498.
doi: 10.4022/jafib.1498. eCollection 2016 Dec.

Structured care of patients with atrial fibrillation improves guideline adherence

Neshro Barmano  1   2   3 , Ulla Walfridsson  2   2 , Håkan Walfridsson  3   3 , Jan-Erik Karlsson  4   4   4
Affiliations

Structured care of patients with atrial fibrillation improves guideline adherence

Neshro Barmano et al. J Atr Fibrillation. .

Abstract

Aims: There are many reports of lack of guideline adherence in the treatment of patients with atrial fibrillation (AF), and AF affects health-related quality of life (HRQoL) negatively. The aim of this study was to investigate whether structured care compared to standard care of a general AF population could improve guideline adherence and HRQoL, and reduce symptoms,anxiety and depression.

Methods: In total, 176 patients were recruited to the intervention and 146 patients to the control group.The intervention consisted of a structured follow-up program, while patients serving as controls received standard care. The primary outcome was guideline adherence evaluated through: appropriate use of oral anticoagulants (OAC) and antiarrhythmics, whether echocardiogram and thyroid lab tests were performed, and patient-reported outcome measures (PROMs), assessed with the questionnaires SF-36, EQ-5D, HADS and ASTA at baseline and after one year.

Results: Guideline adherence was significantly better in the intervention group, 91% vs. 63% (p < 0.01), mainly due to appropriate OAC treatment 94% vs. 74% (p < 0.01). Symptoms assessed with ASTA were less frequent and the negative impact of AF was reduced in the intervention group after one year/ at follow-up. Five scales in SF-36, and the visual analogue scale for current health status in EQ-5D (EQ-VAS), improved significantly in both groups.

Conclusion: Structured care of patients with AF significantly improved guideline adherence and patients reported fewer symptoms and a reduced negative impact on disease-specific HRQoL compared to standard care at one year follow-up.

Keywords: Anticoagulants; Anxiety; Atrial fibrillation; Guideline Adherence; Health-related Quality of life; Symptoms.

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Figures

Figure 1.
Figure 1.. Study inclusion flowchart
Figure 2.
Figure 2.. The proportion of patients in the intervention and control groups treated with oral anticoagulation (OAC) according to guidelines using the CHADS2-criteria (A) and the CHA2DS2-VASc-criteria (B) at baseline and at follow-up after one year.
Figure 3.
Figure 3.. Percentage of patients with any degree of symptoms, assessed with the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) at baseline and after one year in the control and the intervention groups.
Figure 4.
Figure 4.. SF-36 scores (means) in the control and intervention groups at baseline and after one year compared to a Swedish norm population, aged 65 to 74 years.
See this image and copyright information in PMC

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