Key result
PCP continuity in AF linked to ~21% lower all-cause mortality.
Why the study?
The increasing prevalence of AF requires integrated care pathways centered on primary care physicians, and this study evaluated the impact of longitudinal continuity of care by the same physician on clinical outcomes in AF patients.
Does primary care physician continuity of care reduce mortality and hospitalizations in patients with atrial fibrillation?
Cohort (n=17,889)
Does primary care physician continuity of care reduce mortality and hospitalizations in patients with atrial fibrillation?
Longitudinal continuity of care with the same primary care physician is associated with better oral anticoagulation indication and a significant reduction in all-cause mortality and hospitalizations in patients with atrial fibrillation.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The most striking result is that stable care was associated with a 21% reduction in all-cause mortality (hazard ratio (HR) 0.79 [95% confidence interval (CI): 0.69–. 0.91]) at one year follow-up, which was robust to sensitivity analysis including analysing continuity of care as continuous rather than categorical. This important finding also appeared to be consistent across the study period.”
Supports PCP continuity in AF; extends observational data but leaves causal effects open pending trials.
Background Patients with atrial fibrillation (AF) deserve an early diagnostic and personalized treatment particularly the use of oral anticoagulation (OAC) after a comprehensive clinical assessment for identify other conditions associated with the arrythmia and the high comorbidity burden frequently present in those patients1. Due to the increased prevalence of AF, it is needed an integrated patient-care pathway with primary care physicians (PCP) playing the central role1. Continuity of care (COC) by PCPs involves an ongoing relationship between a patient and a PCP, who takes responsibility for the patient’s medical needs. Longitudinal PCP-COC is defined as the persistence of contact between physicians and patients over time, has been associated with lower mortality rates, fewer hospital admissions, less use of emergency department visits, and fewer referrals for specialist consultation. The aim of our study is to assess the impact of Continuity of Care (COC)—care provided by the same Primary Care Physician (PCP)—on outcomes in patients with atrial fibrillation (AF). Methods We conducted a retrospective cohort study including all patients with AF referred by PCPs (n=17,889) between January 2010 and December 2023 in the Santiago de Compostela healthcare area (Spain). COC was categorized as "PCP stability" (care by the assigned PCP) or "interrupted COC" (care by multiple rotating PCPs). The association between COC and outcomes (hospitalization, mortality, stroke, and haemorrhage) was estimated using Cox regression and Fine-Gray competing risk models, adjusted for potential confounders. Results Patients with PCP stability had a significantly lower annual referral rate (1.5 vs. 1.8, p<0.001) and a higher rate of adequate Oral Anticoagulation (OAC) indication according to the CHA₂DS₂-VASc score (79.5% vs. 69.1%, p<0.001). COC was independently associated with reduced all-cause mortality (Hazard Ratio [95% CI]: 0.79 [0.69–0.91]), and also all-cause (HR: 0.85 [0.80 - 0.91]), CV (HR: 0.85 [0.78 - 0.93]) and HF (HR: 0.70 [0.55 - 0.90]) hospitalizations. A benefit that remained robust after sensitivity analyses. No significant differences were observed in stroke (HR: 1.06 [0.75-1.50]) or haemorrhagic complications (HR: 1.29 [0.98-1.69]); however, competing risk analysis suggests that the higher mortality rate in the interrupted COC group likely precluded the observation of non-fatal events in this high-risk subset. Conclusions Longitudinal COC in Primary Care is associated with improved clinical management, including better OAC indication, and a significant reduction in all-cause mortality among patients with AF. The survival benefit of seeing the same physician appears to extend beyond anticoagulation optimization, highlighting the pleiotropic value of the patient-physician relationship.
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Gonzalez-Juanatey et al. (2026) conducted a cohort in Atrial fibrillation (n=17,889). Primary care physician continuity of care (PCP stability) vs. Interrupted continuity of care (care by multiple rotating PCPs) was evaluated on All-cause mortality (HR 0.79, 95% CI 0.69-0.91). Primary care physician continuity of care in AF patients was independently associated with reduced all-cause mortality (HR 0.79; 95% CI 0.69-0.91) and all-cause hospitalization (HR 0.85).
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