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Specialized clinic improved outcome in patients with AF

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American College of Cardiology 60th Annual Scientific Sessions

NEW ORLEANS – Rates of CV-related mortality and hospitalization were improved in patients with atrial fibrillation treated in a specialized clinic that adheres to AF guidelines when compared with usual care, according to new data.

“In order to improve outcomes in our patients, we developed a AF clinic which was characterized by substation of care by specialized nurses and they also delegated a software program … which stays with you and warns you in case you’ve made the wrong decision and it also suggests the most appropriate therapy,” said Robert G. Tieleman, MD, PhD, study investigator and cardiologist at the Martini Hospital, Groningen, the Netherlands, in a press conference. “We believed that doing this approach would improve outcome in these patients.”

Tieleman and fellow researchers tested this theory by analyzing the outcomes of patients (n=712) who were newly diagnosed with AF referred to the specialized AF clinic (n=356) or usual care (n=356). Baseline data revealed similar rates of CV conditions including hypertension, stroke, coronary artery disease and HF between the AF clinic and usual care arms. The primary endpoint was a composite of CV mortality, life-threatening effects of drugs, and hospitalization due to HF, stroke, acute MI, systemic embolism, bleeding and arrhythmic events.

After a mean 22-month follow-up, the primary endpoint was reported in 14.3% of the AF clinic arm vs. 20.8% of the usual care arm (HR=0.65; 95% CI, 0.45-0.93). Lower rates were also found in the AF clinic arm regarding deaths (1.1% vs. 3.9%; HR=0.28, 95% CI 0.09-0.85) and hospitalizations (13.5% vs. 19.1%; HR=0.66; 95% CI 0.46-0.96).

In his concluding remarks, Tieleman said that this study is at least the first step towards treating more patients with this approach, “but we also have to improve cost-effectiveness,” he said. “But I think these are very promising data.” – by Brian Ellis

For more information:

• Hendriks J. Featured Clinical Research, Session 3016. Presented at: ACC 60th Annual Scientific Sessions; April 2-5, 2011; New Orleans.

I think that these types of approaches are going to be health care of the future – that is, health care teams where cardiac care associates and nurse practitioners are going to have a huge role in the chronic management of these patients with chronic diseases. How that will interface with primary care, family medicine and general internal medicine I think has yet to be completely sorted out, but I think the healthcare team approach as you’ve seen here is going to be what we are going to see and what we should see, and will result in better care.

– David R. Holmes, Jr. , MD
Cardiology Today Editorial Board

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