An Integrated Management Approach to Atrial Fibrillation
Open accessAbstract
BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia resulting in mortality and morbidity. Gaps in oral anticoagulation and education of patients regarding AF have been identified as areas that require improvement. METHODS AND RESULTS: A before-and-after study of 433 patients with newly diagnosed AF in the 3 emergency departments in Nova Scotia from January 1, 2011 until January 31, 2014 was performed. The "before" phase underwent the usual-care pathway for AF management; the "after" phase was enrolled in a nurse-run, physician-supervised AF clinic. The primary outcome was a composite of death, cardiovascular hospitalization, and AF-related emergency department visits. A propensity analysis was performed to account for differences in baseline characteristics. RESULTS: A total of 185 patients were enrolled into the usual-care group, and 228 patients were enrolled in the AF clinic group. The mean age was 64±15 years and 44% were women. In a propensity-matched analysis, the primary outcome occurred in 44 (26.2%) patients in the usual-care group and 29 (17.3%) patients in the AF clinic group (odds ratio 0.71; 95% CI [0.59, 1]; P=0.049) at 12 months. Prescription of oral anticoagulation was increased in the CHADS2 ≥2 group (88.4% in the AF clinic versus 58.5% in the usual-care group, P<0.01). CONCLUSIONS: Adoption of this integrated management approach for the burgeoning population of AF may provide an overall benefit to cardiovascular morbidity and mortality.
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A further non-randomized study identified a trend for a lower rate of the composite outcome of death, cardiovascular hospitalization, and AF-related emergency visits.
“and a further non-randomized study identified a trend for a lower rate of the composite outcome of death, cardiovascular hospitalization, and AF-related emergency visits.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [335]
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- Authors
- Carter, L., Gardner, M., Magee, K., Fearon, A., Morgulis, I., Doucette, S., Sapp, J. L., Gray, C., Abdelwahab, A., & Parkash, R.
- Affiliations
- Queen Elizabeth II Health Sciences Centre (CA)
- Dalhousie University (CA)
- Corresponding author
- Parkash, Ratika
- Venue
- Journal of the American Heart Association
- Published
- 2016-01-13
- Volume
- 5
- Issue
- 1
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC4859404
- OpenAlex
- W2274227601
- Cited by
- 118
- References
- 21
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 10 · 2023: 9 · 2022: 11 · 2021: 10 · 2020: 16 · 2019: 19 · 2018: 19 · 2017: 8 · 2016: 6
- FWCI
- 14.27
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Pfizer
- Bayer Canada
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- atrial fibrillation, integrated care pathways, nurse-led clinics, oral anticoagulation, CHADS2 score, cardiovascular hospitalization, emergency department visits, cardiovascular mortality, patient education, newly diagnosed atrial fibrillation
- MeSH terms
- Administration, Oral, Aged, Anticoagulants, Atrial Fibrillation, Cooperative Behavior, Emergency Service, Hospital, Female, Hospitalization, Humans, Male, Middle Aged, Nova Scotia, Outpatient Clinics, Hospital, Patient Care Team, Prospective Studies, Risk Factors, Time Factors, Odds Ratio, Treatment Outcome, Delivery of Health Care, Integrated, Stroke, Interdisciplinary Communication, Propensity Score
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