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Integrated speciali...
Integrated specialized atrial fibrillation clinics reduce all-cause mortality: post hoc analysis of a randomized clinical trial
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- Hendriks, Jeroen (författare)
- Linköpings universitet,Avdelningen för omvårdnad,Medicinska fakulteten,Maastricht Univ, Netherlands; Univ Adelaide, Australia; Royal Adelaide Hosp, Australia
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- Tieleman, Robert G. (författare)
- Martini Hosp Groningen, Netherlands
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- Vrijhoef, Hubertus J. M. (författare)
- Maastricht Univ, Netherlands; Vrije Univ Brussel, Belgium; Panaxea Bv, Netherlands
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- Wijtvliet, Petra (författare)
- Maastricht Univ, Netherlands; Martini Hosp Groningen, Netherlands
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- Gallagher, Celine (författare)
- Univ Adelaide, Australia; Royal Adelaide Hosp, Australia
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- Prins, Martin H. (författare)
- Maastricht Univ, Netherlands
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- Sanders, Prashanthan (författare)
- Univ Adelaide, Australia; Royal Adelaide Hosp, Australia
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- Crijns, Harry J. G. M. (författare)
- Maastricht Univ, Netherlands
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(creator_code:org_t)
- 2019-08-07
- 2019
- Engelska.
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Ingår i: Europace. - : OXFORD UNIV PRESS. - 1099-5129 .- 1532-2092. ; 21:12, s. 1785-1792
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- Aims An integrated chronic care programme in terms of a specialized outpatient clinic for patients with atrial fibrillation (AF), has demonstrated improved clinical outcomes. The aim of this study is to assess all-cause mortality in patients in whom AF management was delivered through a specialized outpatient clinic offering an integrated chronic care programme. Methods and results Post hoc analysis of a Prospective Randomized Open Blinded Endpoint Clinical trial to assess all-cause mortality in AF patients. The study included 712 patients with newly diagnosed AF, who were referred for AF management to the outpatient service of a University hospital. In the specialized outpatient clinic (AF-Clinic), comprehensive, multidisciplinary, and patient-centred AF care was provided, i.e. nurse-driven, physician supervised AF treatment guided by software based on the latest guidelines. The control group received usual care by a cardiologist in the regular outpatient setting. After a mean follow-up of 22months, all-cause mortality amounted 3.7% (13 patients) in the AF-Clinic arm and 8.1% (29 patients) in usual care [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.23-0.85; P = 0.014]. This included cardiovascular mortality in 4 AF-Clinic patients (1.1%) and 14 patients (3.9%) in usual care (HR 0.28; 95% CI 0.09-0.85; P = 0.025). Further, 9 patients (2.5%) died in the AF-Clinic arm due to a non-cardiovascular reason and 15 patients (4.2%) in the usual care arm (HR 0.59; 95% CI 0.26-1.34; P = 0.206). Conclusion An integrated specialized AF-Clinic reduces all-cause mortality compared with usual care. These findings provide compelling evidence that an integrated approach should be widely implemented in AF management.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- Atrial fibrillation; Integrated care; Mortality; Multidisciplinary teams; Nurse co-ordination
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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