ObjectiveA 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.MethodsAll 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.ResultsA 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).ConclusionsStructured, 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.

WHAT THIS PAPER ADDS This is the first study to report adherence to preventive cardiovascular medication among 65e74 year old men diagnosed with abdominal aortic aneurysm or peripheral arterial disease in a multifaceted screening trial for cardiovascular disease. At the five year follow up, drug initiation and adherence to recommended cardiovascular preventive treatments were low among non-users of antiplatelet and statin treatment at screening. Drug adherence among users at screening exceeded 80%. The effectiveness of screening is, to some extent, offset by the poor fulfilment of preventive treatment. Research initiatives in future trials are required to increase initiation and persistence, especially among non-users at baseline. Objective: Adherence to antiplatelet and statin therapy in participants diagnosed with abdominal aortic aneurysm (AAA) or peripheral arterial disease (PAD) was examined in a vascular screening trial. Methods: This was a population based cohort study. The study population consisted of 65e74 year old men diagnosed with AAA or PAD in the Viborg Vascular (VIVA) multifaceted screening trial for CVD. Data from the VIVA screening cohort were linked to data from Danish registers from 2007 to 2016. Initiation of antiplatelet and statin treatment was measured within 120 days after screening. Persistence was defined as no treatment gap >100 days between two prescription renewals after screening. A proportion of days covered !80% over five years of follow up was used as a categorical cut off for adherence. Results: Among the 18,748 screened participants, 618 with AAA and 2051 with PAD were identified. Among non-users at baseline, 65% and 62% initiated antiplatelet and statin treatment, 57% and 59% persisted with antiplatelet and statin use, and 60% and 57% were adherent, respectively. Among users at baseline, 73% and 69% had filled an antiplatelet or statin prescription, respectively, within 120 days after screening. Further, 79% and 73% persisted with their antiplatelet and statin treatment, and 89% and 83% were adherent, respectively. Conclusion: In a vascular screening trial, six of every 10 non-users initiated preventive treatment; among these, the adherence rate was 57e60%. Among users at baseline, the five year adherence to antiplatelet and statin treatment exceeded 80%. The effectiveness of screening initiatives might be improved by measures to improve the fulfilment of preventive medication.

Adherence to phase II CR was high in both groups. SC-CR did not improve adherence and efficacy, but had comparable effects on medication and risk factors. Thus, SC-CR was safe and effective.

Atrial fibrillation (AF) is a chronic disease with an incidence increasing steeply by age and affecting more than 11 million patients in Europe and the United States. Diagnosing AF is essential for the prevention of stroke by oral anticoagulation. Opportunistic screening for AF in patients ≥65 years of age is recommended by the European and Danish Societies of Cardiology. The study aim was to examine the detection rate of AF in consecutively screened patients in the primary care setting in Denmark. In an open, non-interventional, cluster, multicenter, cross-sectional, observational study patients ≥65 years of age entering consecutively into general practice clinics were invited to nurse-assisted opportunistic screening for AF. The General Practice (GP) clinics participating were randomized to patient inclusion in three age groups: 65–74, 75–84, and ≥85 years respectively. All patients underwent pulse palpation followed by 12-led electrocardiogram in case of irregular pulse. Two cardiologists validated all electrocardiogram examinations. Forty-nine general practice clinics recruited in total 970 patients split into three age groups; 480 patients (65–74 years), 372 (75–84 years), and 118 patients ≥85 years of age. Co-morbidities increased by age with hypertension being most frequent. Eighty-seven patients (9%) were detected with an irregular pulse, representing 4.4%, 10.5% and 22.9%, respectively in the three age groups. Assessment of electrocardiograms by the GP showed suspicion of AF in 13 patients with final verification of electrocardiograms by cardiologists revealing 10 AF-patients. The highest detection rate of AF was found in the ≥85 age group (3.39%) followed by the 65–74 age group (0.83%) and the 75–84 age group (0.54%). Opportunistic screening of AF in primary care is feasible and do result in the detection of new AF-patients. Close collaboration with cardiologists is advisable to avoid false positive screening results.

It is well established that pharmacological treatment for cardiovascular diseases (CVD), such as statins and antithrombotic and antihypertensive agents, reduces the risk of cardiovascular events. 1 Prevention of CVD may involve health checks and screening tests to reveal asymptomatic diseases among citizens of risk of CVD. However, the effectiveness of such screening has been debated. 2-5 The Viborg Vascular (VIVA) multifaceted screening trial for vascular disease reported that screening for abdominal aortic

BackgroundIn general, it is assumed that patient education, by increasing knowledge, may change behavior and lifestyle and promote health. In this context, it is a surprise that knowledge and awareness about blood pressure and hypertension among elderly people is poor. We hypothesized that knowledge about blood pressure and hypertension would be better among individuals with self-reported hypertension compared with subjects without self-reported hypertension.MethodsWe mailed a questionnaire to a random sample of 1,000 subjects living in the municipality of Silkeborg, Denmark. The study sample was drawn from the Central Person Registry.ResultsThe response rate was 72%. Of these, 43% of responders had self-reported hypertension. The people with self-reported hypertension were older, less educated, had higher self-reported blood cholesterol levels, had higher body weight, and more often had a family history of hypertension. More than 80% reported that overweight and obesity increases blood pressure. More than 60% reported that untreated hypertension may cause heart disease or stroke. More than half of the responders did not know their blood pressure, and only 21% knew that hypertension can occur without symptoms. Knowledge about hypertension was independent of self-reported hypertension status, but awareness about blood pressure was most prominent among those with self-reported hypertension.ConclusionGeneral knowledge about blood pressure and hypertension was reasonable, but there is still room for improvement in elderly people’s knowledge and awareness of blood pressure.

Background: Atrial fibrillation (AF) is an emerging epidemic associated with poor mental health and quality of life, as well as morbidity and mortality. Whilst other cardiovascular conditions have demonstrated positive outcomes from educational programmes, this approach is not well integrated in clinical practice in patients with AF. Though evidence in this area is mounting, a thorough overview seems to be lacking. Aim: To assess benefits and harms of educational interventions compared with no intervention in adults with AF. Method: A systematic review and meta-analysis were performed including the outcomes: Serious adverse events (mortality and readmission), mental health (anxiety and depression), physical capacity, quality of life and self-reported incidence of symptoms of AF. PubMed, Embase, CINAHL, Cochrane Library and PsycINFO were searched between June and august 2018. Data extraction and quality assessment were performed independently by two reviewers. The Cochrane Risk of Bias tool was applied for the randomised controlled trials and the Amstar Checklist for the systematic reviews. Results: Eight randomised controlled trials and one non-randomised interventional study were included, with a total of 2388 patients. Comparing with controls patient education was associated with a reduction in: Serious adverse events (Risk Ratio 0.78, CI 95% 0.63-0.97), anxiety with a mean difference of −0.62 (CI 95% −1.21, −0.04) and depression with a mean difference of −0.74 (CI 95% −1.34, −0.14). Health-related quality of life and physical capacity was found to increase after patient education, yet, only one study found statistically significant differences between groups. No differences were observed with regards to self-reported incidence of symptoms of AF. Conclusions: Educational interventions significantly decrease the number of serious adverse events in patients with AF and seem to have a positive impact on mental health and self-reported quality of life. However, the evidence is limited, and more studies are warranted.

Background Clinical practice guidelines recommend patient education for patients with atrial fibrillation (AF) as a part of holistic care, however clinical guidelines lack detailed specification the content, structure, and delivery of AF education programmes. Aim To examine the implementation of education for patients with AF in Denmark in relation to coverage, organization and content. Methods A cross-sectional survey was conducted from February to May 2021. The survey contained questions on the organization, delivery and content of education for patients with AF from all 29 AF outpatient hospital sites in Denmark. The survey was conducted by email and telephone. One-year follow-up was done in May 2022 by e-mail. Results Patient education was provided by healthcare professionals in 16 (55%) hospitals. Nurse workforce issues, management, non-prioritisation, and lack of guidance for implementation were reasons for the absence of patient education in 13 (45%) hospitals. The structure of patient education differed in relation to group or individual teaching methods and six different education models were used. Content of the AF disease education was generally similar. At 1-year follow-up, another four hospitals reported offering patient education (69% in total). Conclusion Initially almost half of the hospitals did not provide patient education, but at 1-year follow-up 69% of hospitals delivered patient education. Patient education was heterogeneous in relation to delivery, frequency and duration. Future research should address individualized patient education that may demonstrate superiority in relation to quality of life, less hospital admissions, and increased longevity.