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Nurse-led vs. usual-care for atrial fibrillation

Wijtvliet, E. P. J. P., Tieleman, R. G., van Gelder, I. C., Pluymaekers, N. A. H. A., Rienstra, M., Folkeringa, R. J., Bronzwaer, P., Elvan, A., Elders, J., Tukkie, R., Luermans, J. G. L. M., Van Asselt, A. D. I. T., Van Kuijk, S. M. J., Tijssen, J. G. & Crijns, H. J. G. M., 23-Sep-2019, In : European Heart Journal. 8 p.

Research output: Contribution to journalArticleAcademicpeer-review

BACKGROUND: Nurse-led integrated care is expected to improve outcome of patients with atrial fibrillation compared with usual-care provided by a medical specialist.

METHODS AND RESULTS: We randomized 1375 patients with atrial fibrillation (64 ± 10 years, 44% women, 57% had CHA2DS2-VASc ≥ 2) to receive nurse-led care or usual-care. Nurse-led care was provided by specialized nurses using a decision-support tool, in consultation with the cardiologist. The primary endpoint was a composite of cardiovascular death and cardiovascular hospital admissions. Of 671 nurse-led care patients, 543 (81%) received anticoagulation in full accordance with the guidelines against 559 of 683 (82%) usual-care patients. The cumulative adherence to guidelines-based recommendations was 61% under nurse-led care and 26% under usual-care. Over 37 months of follow-up, the primary endpoint occurred in 164 of 671 patients (9.7% per year) under nurse-led care and in 192 of 683 patients (11.6% per year) under usual-care [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.69 to 1.04, P = 0.12]. There were 124 vs. 161 hospitalizations for arrhythmia events (7.0% and 9.4% per year), and 14 vs. 22 for heart failure (0.7% and 1.1% per year), respectively. Results were not consistent in a pre-specified subgroup analysis by centre experience, with a HR of 0.52 (95% CI 0.37-to 0.71) in four experienced centres and of 1.24 (95% CI 0.94-1.63) in four less experienced centres (P for interaction <0.001).

CONCLUSION: Our trial failed to show that nurse-led care was superior to usual-care. The data suggest that nurse-led care by an experienced team could be clinically beneficial (ClinicalTrials.gov NCT01740037).

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT01740037).

Original languageEnglish
Number of pages8
JournalEuropean Heart Journal
Publication statusE-pub ahead of print - 23-Sep-2019

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