Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation
The management of patients with atrial fibrillation (AF) is often inadequate due to deficient adherence to the guidelines. A nurse-led AF clinic providing integrated chronic care to improve guideline adherence and activate patients in their role, may effectively reduce morbidity and mortality but su...
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| Veröffentlicht in: | European heart journal 2012-11, Vol.33 (21), p.2692-2699 |
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| creator | HENDRIKS, Jeroen M. L DE WIT, Rianne CRIJNS, Harry J. G. M VRIJHOEF, Hubertus J. M PRINS, Martin H PISTERS, Ron PISON, Laurent A. F. G BLAAUW, Yuri TIELEMAN, Robert G |
| description | The management of patients with atrial fibrillation (AF) is often inadequate due to deficient adherence to the guidelines. A nurse-led AF clinic providing integrated chronic care to improve guideline adherence and activate patients in their role, may effectively reduce morbidity and mortality but such care has not been tested in a large randomized trial. Therefore, we performed a randomized clinical trial to compare the AF clinic with routine clinical care in patients with AF.
We randomly assigned 712 patients with AF to nurse-led care and usual care. Nurse-led care consisted of guidelines based, software supported integrated chronic care supervised by a cardiologist. The primary endpoint was a composite of cardiovascular hospitalization and cardiovascular death. Duration of follow-up was at least 12 months. Adherence to guideline recommendations was significantly better in the nurse-led care group. After a mean of 22 months, the primary endpoint occurred in 14.3% of 356 patients of the nurse-led care group compared with 20.8% of 356 patients receiving usual care [hazard ratio: 0.65; 95% confidence interval (CI) 0.45-0.93; P= 0.017]. Cardiovascular death occurred in 1.1% in the nurse-led care vs. 3.9% in the usual care group (hazard ratio: 0.28; 95% CI: 0.09-0.85; P= 0.025). Cardiovascular hospitalization amounted (13.5 vs. 19.1%, respectively, hazard ratio: 0.66; 95% CI: 0.46-0.96, P= 0.029).
Nurse-led care of patients with AF is superior to usual care provided by a cardiologist in terms of cardiovascular hospitalizations and cardiovascular mortality. Trial registration information: Clinicaltrials.gov identifier number: NCT00391872. |
| doi_str_mv | 10.1093/eurheartj/ehs071 |
| format | Article |
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We randomly assigned 712 patients with AF to nurse-led care and usual care. Nurse-led care consisted of guidelines based, software supported integrated chronic care supervised by a cardiologist. The primary endpoint was a composite of cardiovascular hospitalization and cardiovascular death. Duration of follow-up was at least 12 months. Adherence to guideline recommendations was significantly better in the nurse-led care group. After a mean of 22 months, the primary endpoint occurred in 14.3% of 356 patients of the nurse-led care group compared with 20.8% of 356 patients receiving usual care [hazard ratio: 0.65; 95% confidence interval (CI) 0.45-0.93; P= 0.017]. Cardiovascular death occurred in 1.1% in the nurse-led care vs. 3.9% in the usual care group (hazard ratio: 0.28; 95% CI: 0.09-0.85; P= 0.025). Cardiovascular hospitalization amounted (13.5 vs. 19.1%, respectively, hazard ratio: 0.66; 95% CI: 0.46-0.96, P= 0.029).
Nurse-led care of patients with AF is superior to usual care provided by a cardiologist in terms of cardiovascular hospitalizations and cardiovascular mortality. Trial registration information: Clinicaltrials.gov identifier number: NCT00391872.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehs071</identifier><identifier>PMID: 22453654</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Aged ; Ambulatory Care - methods ; Atrial Fibrillation - mortality ; Atrial Fibrillation - nursing ; Atrial Fibrillation - therapy ; Biological and medical sciences ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Delivery of Health Care, Integrated ; Female ; Heart ; Hospitalization - statistics & numerical data ; Humans ; Kaplan-Meier Estimate ; Male ; Medical sciences ; Netherlands ; Practice Patterns, Nurses ; Proportional Hazards Models ; Treatment Outcome</subject><ispartof>European heart journal, 2012-11, Vol.33 (21), p.2692-2699</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c371t-264ccb236b847732a2eba55ec1028127f6b152ecfe5e772542b0b81ef34042613</citedby><cites>FETCH-LOGICAL-c371t-264ccb236b847732a2eba55ec1028127f6b152ecfe5e772542b0b81ef34042613</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26549538$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22453654$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>HENDRIKS, Jeroen M. L</creatorcontrib><creatorcontrib>DE WIT, Rianne</creatorcontrib><creatorcontrib>CRIJNS, Harry J. G. M</creatorcontrib><creatorcontrib>VRIJHOEF, Hubertus J. M</creatorcontrib><creatorcontrib>PRINS, Martin H</creatorcontrib><creatorcontrib>PISTERS, Ron</creatorcontrib><creatorcontrib>PISON, Laurent A. F. G</creatorcontrib><creatorcontrib>BLAAUW, Yuri</creatorcontrib><creatorcontrib>TIELEMAN, Robert G</creatorcontrib><title>Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>The management of patients with atrial fibrillation (AF) is often inadequate due to deficient adherence to the guidelines. A nurse-led AF clinic providing integrated chronic care to improve guideline adherence and activate patients in their role, may effectively reduce morbidity and mortality but such care has not been tested in a large randomized trial. Therefore, we performed a randomized clinical trial to compare the AF clinic with routine clinical care in patients with AF.
We randomly assigned 712 patients with AF to nurse-led care and usual care. Nurse-led care consisted of guidelines based, software supported integrated chronic care supervised by a cardiologist. The primary endpoint was a composite of cardiovascular hospitalization and cardiovascular death. Duration of follow-up was at least 12 months. Adherence to guideline recommendations was significantly better in the nurse-led care group. After a mean of 22 months, the primary endpoint occurred in 14.3% of 356 patients of the nurse-led care group compared with 20.8% of 356 patients receiving usual care [hazard ratio: 0.65; 95% confidence interval (CI) 0.45-0.93; P= 0.017]. Cardiovascular death occurred in 1.1% in the nurse-led care vs. 3.9% in the usual care group (hazard ratio: 0.28; 95% CI: 0.09-0.85; P= 0.025). Cardiovascular hospitalization amounted (13.5 vs. 19.1%, respectively, hazard ratio: 0.66; 95% CI: 0.46-0.96, P= 0.029).
Nurse-led care of patients with AF is superior to usual care provided by a cardiologist in terms of cardiovascular hospitalizations and cardiovascular mortality. Trial registration information: Clinicaltrials.gov identifier number: NCT00391872.</description><subject>Aged</subject><subject>Ambulatory Care - methods</subject><subject>Atrial Fibrillation - mortality</subject><subject>Atrial Fibrillation - nursing</subject><subject>Atrial Fibrillation - therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. Vascular system</subject><subject>Delivery of Health Care, Integrated</subject><subject>Female</subject><subject>Heart</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Netherlands</subject><subject>Practice Patterns, Nurses</subject><subject>Proportional Hazards Models</subject><subject>Treatment Outcome</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU9v1DAQxS0Eokvhzgn5gtRLWv-JnYQbqiggVfRSJG6R7R2zrpJ4GdtF5QvytXCVbXvkZHnmN_NG7xHylrNTzgZ5BgV3YDDfnMEusY4_IxuuhGgG3arnZMP4oBqt-x9H5FVKN4yxXnP9khwJ0SqpVbshf78VTNBMsKXOINDbdEpLKmZavz4i3ZscYMmJ_g55R03GULs-WAzTVFtx-UARUpkqET01FM2yjXP4U1eubK2GJcNPNPleZodxCe5JDmPJYQHqplDrD8phoWa2pSpEvPv_Da_JC2-mBG8O7zH5fvHp-vxLc3n1-ev5x8vGyY7nRujWOSuktn3bdVIYAdYoBY4z0XPReW2rgeA8KOg6oVphme05eNmyVmguj8nJuneP8VeBlMc5JAf1igViSSPnQmvO9DBUlK2ow5gSgh_3GGaDdyNn431842N84xpfHXl32F7sDNvHgYe8KvD-AJhUrfLVaxfSE1eZQcle_gM4TatJ</recordid><startdate>20121101</startdate><enddate>20121101</enddate><creator>HENDRIKS, Jeroen M. L</creator><creator>DE WIT, Rianne</creator><creator>CRIJNS, Harry J. G. M</creator><creator>VRIJHOEF, Hubertus J. M</creator><creator>PRINS, Martin H</creator><creator>PISTERS, Ron</creator><creator>PISON, Laurent A. F. G</creator><creator>BLAAUW, Yuri</creator><creator>TIELEMAN, Robert G</creator><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20121101</creationdate><title>Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation</title><author>HENDRIKS, Jeroen M. L ; DE WIT, Rianne ; CRIJNS, Harry J. G. M ; VRIJHOEF, Hubertus J. M ; PRINS, Martin H ; PISTERS, Ron ; PISON, Laurent A. F. G ; BLAAUW, Yuri ; TIELEMAN, Robert G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c371t-264ccb236b847732a2eba55ec1028127f6b152ecfe5e772542b0b81ef34042613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Ambulatory Care - methods</topic><topic>Atrial Fibrillation - mortality</topic><topic>Atrial Fibrillation - nursing</topic><topic>Atrial Fibrillation - therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology. Vascular system</topic><topic>Delivery of Health Care, Integrated</topic><topic>Female</topic><topic>Heart</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Netherlands</topic><topic>Practice Patterns, Nurses</topic><topic>Proportional Hazards Models</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>HENDRIKS, Jeroen M. L</creatorcontrib><creatorcontrib>DE WIT, Rianne</creatorcontrib><creatorcontrib>CRIJNS, Harry J. G. M</creatorcontrib><creatorcontrib>VRIJHOEF, Hubertus J. M</creatorcontrib><creatorcontrib>PRINS, Martin H</creatorcontrib><creatorcontrib>PISTERS, Ron</creatorcontrib><creatorcontrib>PISON, Laurent A. F. G</creatorcontrib><creatorcontrib>BLAAUW, Yuri</creatorcontrib><creatorcontrib>TIELEMAN, Robert G</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>HENDRIKS, Jeroen M. L</au><au>DE WIT, Rianne</au><au>CRIJNS, Harry J. G. M</au><au>VRIJHOEF, Hubertus J. M</au><au>PRINS, Martin H</au><au>PISTERS, Ron</au><au>PISON, Laurent A. F. G</au><au>BLAAUW, Yuri</au><au>TIELEMAN, Robert G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2012-11-01</date><risdate>2012</risdate><volume>33</volume><issue>21</issue><spage>2692</spage><epage>2699</epage><pages>2692-2699</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>The management of patients with atrial fibrillation (AF) is often inadequate due to deficient adherence to the guidelines. A nurse-led AF clinic providing integrated chronic care to improve guideline adherence and activate patients in their role, may effectively reduce morbidity and mortality but such care has not been tested in a large randomized trial. Therefore, we performed a randomized clinical trial to compare the AF clinic with routine clinical care in patients with AF.
We randomly assigned 712 patients with AF to nurse-led care and usual care. Nurse-led care consisted of guidelines based, software supported integrated chronic care supervised by a cardiologist. The primary endpoint was a composite of cardiovascular hospitalization and cardiovascular death. Duration of follow-up was at least 12 months. Adherence to guideline recommendations was significantly better in the nurse-led care group. After a mean of 22 months, the primary endpoint occurred in 14.3% of 356 patients of the nurse-led care group compared with 20.8% of 356 patients receiving usual care [hazard ratio: 0.65; 95% confidence interval (CI) 0.45-0.93; P= 0.017]. Cardiovascular death occurred in 1.1% in the nurse-led care vs. 3.9% in the usual care group (hazard ratio: 0.28; 95% CI: 0.09-0.85; P= 0.025). Cardiovascular hospitalization amounted (13.5 vs. 19.1%, respectively, hazard ratio: 0.66; 95% CI: 0.46-0.96, P= 0.029).
Nurse-led care of patients with AF is superior to usual care provided by a cardiologist in terms of cardiovascular hospitalizations and cardiovascular mortality. Trial registration information: Clinicaltrials.gov identifier number: NCT00391872.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>22453654</pmid><doi>10.1093/eurheartj/ehs071</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European heart journal, 2012-11, Vol.33 (21), p.2692-2699 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aged Ambulatory Care - methods Atrial Fibrillation - mortality Atrial Fibrillation - nursing Atrial Fibrillation - therapy Biological and medical sciences Cardiac dysrhythmias Cardiology. Vascular system Delivery of Health Care, Integrated Female Heart Hospitalization - statistics & numerical data Humans Kaplan-Meier Estimate Male Medical sciences Netherlands Practice Patterns, Nurses Proportional Hazards Models Treatment Outcome |
| title | Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation |
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