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Cited by 147Atrial Fibrillation Management and OutcomesHeart Failure Treatment and ManagementCardiac Health and Mental Health

Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial

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Stewart, Simon, Ball, Jocasta, Horowitz, John D, Marwick, Thomas H, Mahadevan, Gnanadevan, Wong, Chiew, Abhayaratna, Walter P, Chan, Yih K +4 more·2015·The Lancet
DOI 10.1016/s0140-6736(14)61992-9
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Abstract

Background Patients are increasingly being admitted with chronic atrial fibrillation, and disease-specific management might reduce recurrent admissions and prolong survival. However, evidence is scant to support the application of this therapeutic approach. We aimed to assess SAFETY--a management strategy that is specific to atrial fibrillation. Methods We did a pragmatic, multicentre, randomised controlled trial in patients admitted with chronic, non-valvular atrial fibrillation (but not heart failure). Patients were recruited from three tertiary referral hospitals in Australia. 335 participants were randomly assigned by computer-generated schedule (stratified for rhythm or rate control) to either standard management (n=167) or the SAFETY intervention (n=168). Standard management consisted of routine primary care and hospital outpatient follow-up. The SAFETY intervention comprised a home visit and Holter monitoring 7-14 days after discharge by a cardiac nurse with prolonged follow-up and multidisciplinary support as needed. Clinical reviews were undertaken at 12 and 24 months (minimum follow-up). Coprimary outcomes were death or unplanned readmission (both all-cause), measured as event-free survival and the proportion of actual versus maximum days alive and out of hospital. Analyses were done on an intention-to-treat basis. The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTRN 12610000221055). Findings During median follow-up of 905 days (…

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  • An Australian RCT showed only a marginal effect on unplanned admissions and death using integrated AF care limited to the initial care period, possibly emphasizing the need for sustained integration of AF care.

    “However, an Australian RCT showed only a marginal effect on unplanned admissions and death using integrated AF care limited to the initial care period, possibly emphasizing the need for sustained integration of AF care.”

    From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [332]

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Authors
Stewart, S., Ball, J., Horowitz, J. D., Marwick, T. H., Mahadevan, G., Wong, C., Abhayaratna, W. P., Chan, Y. K., Esterman, A., Thompson, D. R., Scuffham, P. A., & Carrington, M. J.
Affiliations
  • Baker Heart and Diabetes Institute (AU)
  • Australian Catholic University (AU)
  • Queen Elizabeth Hospital (AU)
  • Footscray Hospital (AU)
  • Australian National University (AU)
  • University of South Australia (AU)
  • Griffith University (AU)
Corresponding author
Stewart, Simon
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2015-02
Volume
385
Issue
9970
Pages
775-784
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(14)61992-9
OpenAlex
W2164162719
Cited by
147
References
9
Citations by year
2026: 6 · 2025: 8 · 2024: 9 · 2023: 9 · 2022: 9 · 2021: 8 · 2020: 17 · 2019: 20 · 2018: 13 · 2017: 10 · 2016: 20 · 2015: 15 · 2014: 3
FWCI
10.93
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • ResearchOnline at James Cook University (James Cook University) (submittedVersion)
  • eCite Digital Repository (University of Tasmania) (submittedVersion)
  • Research Bank (Australian Catholic University) (submittedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • ANU Open Research (Australian National University) (submittedVersion)
  • Research Portal (Queen's University Belfast) (submittedVersion)
  • Griffith Research Online (submittedVersion)
Funders
  • National Health and Medical Research Council
  • National Medical Research Council
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
atrial fibrillation management, safety interventions, home visits, Holter monitoring, cardiac nurses, unplanned hospital readmission, event-free survival, mortality, multidisciplinary follow-up, primary care follow-up, quality of life
MeSH terms
Aged, Atrial Fibrillation, Chronic Disease, Female, Home Care Services, Humans, Length of Stay, Male, Patient Care Team, Patient Readmission, Prospective Studies, Quality of Life, Risk Factors, Electrocardiography, Ambulatory, Treatment Outcome, Kaplan-Meier Estimate, Secondary Prevention

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