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. 2023 Sep 19;20(18):6783.
doi: 10.3390/ijerph20186783.

Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation-REAFEL

Carsten Bamberg  1   2 , Caroline Thorup Ladegaard  1   2 , Mathias Aalling  3 , Dorthea Marie Jensen  1   2 , Christoffer Læssøe Madsen  1   2 , Sadaf Kamil  1   2 , Henrik Gudbergsen  4 , Thomas Saxild  5 , Michaela Louise Schiøtz  6 , Julie Grew  6 , Luana Sandoval Castillo  7 , Iben Tousgaard  8 , Rie Laurine Rosenthal Johansen  8 , Jakob Eyvind Bardram  9 , Anne Frølich  10   11 , Helena Domínguez  1   2
Affiliations

Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation-REAFEL

Carsten Bamberg et al. Int J Environ Res Public Health. .

Abstract

Background: Frail elderly patients are exposed to suffering strokes if they do not receive timely anticoagulation to prevent stroke associated to atrial fibrillation (AF). Evaluation in the cardiological ambulatory can be cumbersome as it often requires repeated visits.

Aim: To develop and implement CardioShare, a shared-care model where primary care leads patient management, using a compact Holter monitor device with asynchronous remote support from cardiologists.

Methods: CardioShare was developed in a feasibility phase, tested in a pragmatic cluster randomization trial (primary care clinics as clusters), and its implementation potential was evaluated with an escalation test. Mixed methods were used to evaluate the impact of this complex intervention, comprising quantitative observations, semi-structured interviews, and workshops.

Results: Between February 2020 and December 2021, 314 patients (30% frail) were included, of whom 75% had AF diagnosed/not found within 13 days; 80% in both groups avoided referral to cardiologists. Patients felt safe and primary care clinicians satisfied. In an escalation test, 58 primary-care doctors evaluated 93 patients over three months, with remote support from four hospitals in the Capital Region of Denmark.

Conclusions: CardioShare was successfully implemented for AF evaluation in primary care.

Keywords: C3+; CardioShare model; Holter; atrial fibrillation; cross-sector collaboration; frail elderly; health professionals; monitoring; sensor.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. Cortrium ApS as one of the partners that received the grant from the Innovation Fund and delivered the Holter monitors (C3+), but had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish results.

Figures

Figure A1
Figure A1
Short version of interview guide.
Figure 1
Figure 1
The CardioShare model.
Figure 2
Figure 2
Distribution of age among all participants by gender; n = 314.
Figure 3
Figure 3
Results of Holter recordings; n = 323.
Figure 4
Figure 4
Duration of diagnostic process from decision to results (days). Top: cluster randomization study (pilot clinic that continued to include patients during same period of time; non-CardioShare clinics; and CardioShare clinics; overall n = 314 patients). Bottom: comparison cohort of patients managed as usual in the hospital’s outpatient department; n = 117 patients. Please be aware of the scale difference between top and bottom parts of the figure.
Figure 5
Figure 5
Survey: How safe did you feel during the whole diagnostic process? n = 102; very unsafe = 3 (2.9%); unsafe = 1 (1.0%); neutral = 6 (5.9%); safe = 26 (25.5%); and very safe = 66 (64.7%).
Figure 6
Figure 6
Survey: Evaluate the organization of the diagnostic process (n = 102); don’t know = 5 (4.9%); very satisfying = 53 (52.0%); satisfying = 28 (27.5%); neutral = 8 (7.8%); unsatisfying = 5 (4.9%); and very unsatisfying = 3 (2.9%).
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