Heartbeat: Healthcare approaches to reducing adverse outcomes in patients with atrial fibrillation

Atrial fibrillation (AF) affects over 30 million people worldwide. The increased risk of stroke and mortality associated with AF accounts for an increasing global burden of disease, both in terms of adverse outcomes and resultant costs. In standard medical practice, adherence to guideline based preventative anticoagulation is suboptimal. An integrated care model, using a multidisciplinary team and community support to provide patient-centred care, has been proposed to improve outcomes in the AF population. In a systematic review and meta-analysis that included 1383 AF patients, Gallagher and colleagues1 found that an integrated care approach was associated with a reduction in both all-cause mortality (OR 0.51, 95%  CI 0.32 to 0.80, p=0.003) and cardiovascular hospitalisations (OR 0.58, 95%  CI 0.44 to 0.77, p=0.0002) (figure 1). However, there was no difference between integrated and standard care for endpoints of AF-related hospitalisations or cerebrovascular events. Figure 1 Impact of integrated care on all-cause mortality. M-H, Mantel-Haenszel method. In an editorial, Stewart2 stresses the contribution of AF to the epidemiology of cardiovascular disease given that the “population prevalence ranges from 2.3%–3.4% with a marked gradient …