Nurse-led counseling after ablation improved patients’ AF knowledge, reduced recurrence
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Key takeaways:
- A nurse-led intervention improved patient knowledge and reduced arrhythmia recurrence after ablation.
- The intervention required about 3.5 hours of work from the nurse and cost less than 100 euros per week.
An advanced nurse practitioner-led intervention after atrial fibrillation ablation could improve patient knowledge, satisfaction, lifestyle modification and AF recurrence, researchers reported.
A randomized controlled trial comparing a nurse-led intervention after AF ablation with usual care was published in the European Journal of Preventive Cardiology.
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“Catheter ablation mainly consisting of pulmonary vein isolation is an established treatment for patients with symptomatic AF. Despite rapid technical evolution and skill development, recurrence of AF is however seen in approximately 10% to 40% of the patients. As a result, a repeat ablation is often required,” Yaël Vanharen, MSc, of the department of health sciences at the University of Antwerp, Belgium, and colleagues wrote. “The potential value of nurse-led care by an advanced practitioner nurse in the follow-up after ablation has not been studied yet. Due to the decrease in hospital duration of patients at the time of ablation, providing the opportunity for patients to ask questions is becoming increasingly important.”
For this study, Vanharen and colleagues enrolled 65 patients undergoing AF ablation and randomly assigned them to the nurse-led intervention or usual care (mean age, 65 years; 55% men). The intervention consisted of an educational session, three consultations over a 6-month period and telephone accessibility coordinated by the advanced nurse practitioner, in addition to usual care.
Primary outcome was the AF recurrence at 6 months. Secondary outcomes included lifestyle factors, patient satisfaction and AF knowledge measured at 1 and 6 months.
Nurse-led counseling vs. usual care after ablation
The researchers observed significant difference in AF knowledge as early as 1 month after ablation, with patients in the nurse-led intervention arm having a higher knowledge score compared with usual care (8.6 vs. 7 out of 10; P = .001).
At 6 months, both patient satisfaction (9.4 vs. 8.7 out of 10; P < .001) and AF knowledge (8.6 vs. 7 out of 10; P < .001) were higher in the intervention group compared with usual care.
Six-month AF recurrence was also lower in the intervention group compared with usual care (13.5% vs. 39.4%; P = .014), according to the study.
From baseline to 6 months, participants in the intervention arm improved lifestyle factors including decreased alcohol intake from 3.9 U to 2.6 U per week (P = .031) and increased mean physical activity from 224.4 to 283.8 minutes per week (P = .048). Researchers observed no lifestyle changes within the usual care group.
Moreover, after multivariable-adjusted analysis, assignment to the advanced nurse practitioner-led intervention was the only protective factor for AF recurrence (OR = 0.299; P = .04).
The researchers estimated that this intervention would require 3.5 hours of work per week from the advanced nurse practitioner, and at 24.9 euros salary per hour, the cost for this intervention is approximately 87 euros per week.
‘The shortcomings’ of current usual care
“This study shows the shortcomings of the current standard clinical follow-up of AF patients after ablation and further supports the growing scientific evidence for a shared follow-up by an advanced nurse practitioner in addition to a cardiologist as a new standard,” the researchers wrote. “Education by an advanced nurse practitioner and motivation for lifestyle change have contributed to a reduction of relapse. On the other hand, anxiety has been suggested to be an independent AF trigger. Preoperative education has been proven to reduce anxiety however, little is known about the influence of education on anxiety and patient outcomes after ablation.”
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