期刊
EUROPEAN HEART JOURNAL
卷 33, 期 21, 页码 2692-2699出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehs071
关键词
Atrial fibrillation; Mortality; Hospital admissions; Adherence to guidelines; Nursing
资金
- University Hospital Maastricht
- Boehringer Ingelheim
- Medtronic Bakken Research Centre
Aims The management of patients with atrial fibrillation (AF) is often inadequate due to deficient adherence to the guidelines. A nurse-led AF clinic providing integrated chronic care to improve guideline adherence and activate patients in their role, may effectively reduce morbidity and mortality but such care has not been tested in a large randomized trial. Therefore, we performed a randomized clinical trial to compare the AF clinic with routine clinical care in patients with AF. Methods and results We randomly assigned 712 patients with AF to nurse-led care and usual care. Nurse-led care consisted of guidelines based, software supported integrated chronic care supervised by a cardiologist. The primary endpoint was a composite of cardiovascular hospitalization and cardiovascular death. Duration of follow-up was at least 12 months. Adherence to guideline recommendations was significantly better in the nurse-led care group. After a mean of 22 months, the primary endpoint occurred in 14.3 of 356 patients of the nurse-led care group compared with 20.8 of 356 patients receiving usual care [hazard ratio: 0.65; 95 confidence interval (CI) 0.45-0.93; P = 0.017]. Cardiovascular death occurred in 1.1 in the nurse-led care vs. 3.9 in the usual care group (hazard ratio: 0.28; 95 CI: 0.09-0.85; P = 0.025). Cardiovascular hospitalization amounted (13.5 vs. 19.1, respectively, hazard ratio: 0.66; 95 CI: 0.46-0.96, P = 0.029). Conclusion Nurse-led care of patients with AF is superior to usual care provided by a cardiologist in terms of cardiovascular hospitalizations and cardiovascular mortality.
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