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Basic and translational research
Original research article
Effectiveness of structured, hospital-based, nurse-led atrial fibrillation clinics: a comparison between a real-world population and a clinical trial population
  1. Ina Qvist1,2,
  2. Jeroen M L Hendriks3,4,
  3. Dorthe S Møller2,5,
  4. Andi E Albertsen2,5,
  5. Helle M Mogensen2,5,
  6. Gitte D Oddershede2,5,
  7. Annette Odgaard1,2,
  8. Leif Spange Mortensen6,
  9. Søren Paaske Johnsen7 and
  10. Lars Frost1,2
  1. 1Department of Medicine, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
  2. 2Cardiovascular Research Centre, Regional Hospital of Central Jutland, Jutland, Denmark
  3. 3Centre for Heart Rhythm Disorders, University of Adelaide, Royal Adelaide Hospital, South Australian Health and Medical Research Institute, Adelaide, Australia
  4. 4Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  5. 5Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
  6. 6Spange Statistics, Lystrup, Denmark
  7. 7Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
  1. Correspondence to Ina Qvist; inaqvist{at}rm.dk

Abstract

Objective A previous randomised trial showed that structured, nurse-led atrial fibrillation (AF) care is superior to conventional AF care, although further research is needed to determine the outcomes of such care in a real-world setting. We compared the outcomes of patients in real-world, nurse-led, structured hospital AF clinics with the outcomes of a randomised trial of the efficacy of a nurse-led AF clinic, with respect to a composite outcome of cardiovascular-related hospitalisation and death.

Methods All patients were referred to the AF nurse specialist by cardiologists. The AF nurse specialist provided patient education, risk-factor control and stimulated empowerment and compliance. During follow-up, treatment was adjusted according to clinical guidelines. Patient education was repeated, and compliance with medical treatment was controlled. The study size was powered as a non-inferiority study. Outcome measures were adjudicated by the same principles in both cohorts.

Results A total of 596 patients from the real world and 356 patients from a clinical trial were included in this study. No significant difference between groups with respect to age, type of AF or CHA2DS2VASc score was found. The composite primary end point occurred with an incidence rate of 8.0 (95% CI 6.1 to 10.4) per 100 person-years in the real-world population and 8.3 (95% CI 6.3 to 10.9) per 100 person-years in the clinical trial, with a crude HR of 0.83 (95% CI 0.56 to 1.23).

Conclusions Structured, nurse-led, hospital-based AF care appears to be effective, and patient outcomes in an actual, hospital-based, structured AF care are as least as good as those in trial settings.

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This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2015-000335

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