The impact of nurse-led atrial fibrillation clinics on patient and healthcare outcomes: a systematic mixed studies review

Rush, Kathy L.; Burton, Lindsay; Schaab, Kira; Lukey, Alexandra

doi:10.1177/1474515119845198

Cited by 32 publications

(46 citation statements)

References 38 publications

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“…36 Regarding usual care. 47,48 The results of our study seem to reinforce the hypotheses of better clinical outcomes in a specific AF clinic led by nurses, since the rate of ischaemic stroke/TIA was significantly lower in the group of patients followed up in this clinic.…”

Section: Discussionsupporting

confidence: 84%

“…Recent systematic reviews and meta‐analyses shown that, in overall, nurse‐led clinics improved healthcare, patient and quality care outcomes. Mortality rates and cardiovascular hospitalisations are lower, whereas patient medication adherence, quality of life and guideline adherence are higher in nurse‐led AF clinics compared to usual care 47,48 . The results of our study seem to reinforce the hypotheses of better clinical outcomes in a specific AF clinic led by nurses, since the rate of ischaemic stroke/TIA was significantly lower in the group of patients followed up in this clinic.…”

Section: Discussionsupporting

confidence: 76%

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A nurse‐led atrial fibrillation clinic: Impact on anticoagulation therapy and clinical outcomes

et al. 2020

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Atrial fibrillation (AF) is the most frequent arrhythmia worldwide and it is associated with increased risk of stroke, thromboembolism and mortality. 1 Nevertheless, these risks can be reduced by using oral anticoagulation (OAC), both Direct Oral Anticoagulants (DOACs) or Vitamin K Antagonists (VKAs). 2 Despite the increasing use of DOACs, VKAs (mainly warfarin and acenocoumarol) are still widely used for stroke prevention in AF in several countries. Notwithstanding, the efficacy and safety of VKAs depend upon the quality of anticoagulation control, as reflected by the average time in therapeutic range (TTR) of international normalised ratio (INR) 2.0-3.0.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 76%

A nurse‐led atrial fibrillation clinic: Impact on anticoagulation therapy and clinical outcomes

et al. 2020

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“…Of these, results demonstrated that a significant proportion of ED patients are appropriate for safe and effective outpatient management of AF. [15][16][17] These pathways include strategies for early rhythm control, initiation of rate control therapies and anticoagulation for stroke prophylaxis. 15 16 However, due to barriers in implementation, these strategies have yet to be maintained nor fully accepted.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent meta-analysis, nurse-led AF clinics were found to be more cost-effective, have shorter wait times and reduce subsequent ED visits and hospitalisations. 17 When compared with standard care, guideline-based medication adherence and patient mortality rates were lower, while quality of life was improved. However, in a study randomising patients with a history of AF to receive nurse-led care or usual care, there was no overall advantage to nurse-led care in a composite of cardiovascular death and cardiovascular hospital admissions.…”

Section: Discussionmentioning

confidence: 99%

Canada-wide mixed methods analysis evaluating the reasons for inappropriate emergency department presentation in patients with a history of atrial fibrillation: the multicentre AF-ED trial

Hong¹,

Babiolakis

Zile

et al. 2020

BMJ Open

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ObjectivesThe primary objective of this study was to ascertain the reasons for emergency department (ED) attendance among patients with a history of atrial fibrillation (AF).DesignAppropriate ED attendance was defined by the requirement for an electrical or chemical cardioversion and/or an attendance resulting in hospitalisation or administration of intravenous medications for ventricular rate control. Quantitative and qualitative responses were recorded and analysed using descriptive statistics and content analysis, respectively. Random effects logistic regression was performed to estimate the OR of inappropriate ED attendance based on clinically relevant patient characteristics.ParticipantsParticipants ≥18 years with a documented history of AF were approached in one of eight centres partaking in the study across Canada (Ontario, Nova Scotia, Alberta and British Columbia).ResultsOf the 356 patients enrolled (67±13, 45% female), the majority (271/356, 76%) had inappropriate reasons for presentation and did not require urgent ED treatment. Approximately 50% of patients(172/356, 48%) were driven to the ED due to symptoms, while the remainder presented on the basis of general fear or anxiety (67/356, 19%) or prior medical advice (117/356, 33%). Random effects logistic regression analysis showed that patients with a history of congestive heart failure were significantly more likely to seek urgent care for appropriate reasons (p=0.03). Likewise, symptom-related concerns for ED presentation were significantly less likely to result in inappropriate visitation (p=0.02). When patients were surveyed on alternatives to ED care, the highest proportion of responses among both groups was in favour of specialised rapid assessment outpatient clinics (186/356, 52%). Qualitative content analysis confirmed these results.ConclusionsImproved education focused on symptom management and alleviating disease-related anxiety as well as the institution of rapid access arrhythmias clinics may reduce the need for unnecessary healthcare utilisation in the ED and subsequent hospitalisation.Trial registration numberNCT03127085

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“…Speciality nurse-led clinics can reduce waiting times to be seen, get diagnosed and receive hospital-based treatment. These clinics are also associated with reduced rates of hospitalisations and overall healthcare costs (Rush et al, 2019).…”

Section: Guest Editorialmentioning

confidence: 99%

Global atrial fibrillation awareness week and the new European Society of Cardiology guidelines

Pearsons

Hanson

Neubeck

2020

British Journal of Cardiac Nursing

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Atrial fibrillation (AF), the most common cardiac arrhythmia, is associated with a five-fold increased risk of stroke (Menke et al, 2010). AF-related stroke is more likely to be fatal or severely disabling compared to other types of stroke, because clots that form in the heart are large and can obstruct large vessels in the brain. This November, the Atrial Fibrillation Association's Global AF Aware Week will draw national attention to: ■ Detecting AF ■ Protecting those with AF from stroke using anticoagulation therapy ■ Correcting irregular rhythms using appropriate treatments ■ Perfecting the patient care pathway (Atrial Fibrillation Association, 2020). Increased clinical understanding and knowledge of recent guidelines among healthcare professionals are necessary to ensure integrated care for those diagnosed with, or suspected of having, AF. The prevalence of AF is increasing and is predicted to double by 2050 (Schnabel et al, 2015), leading to costly and complex hospital admissions and reduced quality of life for patients. Estimates suggest around 1.2 million people in the UK have a diagnosis of AF (Stroke Association, 2017), with a further half a million people currently undiagnosed. The risk of developing AF increases with age and those aged ≥85 years are seven times more likely to have AF than those aged under 55 years (Lane et al, 2017). Other risk factors include diabetes, ethnicity, hypertension, obesity, obstructive sleep apnoea and congestive heart failure. Although it is possible to develop AF without other health conditions, the incidence is higher among complex comorbid populations. Public Health England (2016) have declared that stroke prevention in AF is a national priority. Anticoagulation is a preventative treatment that reduces AF-related stroke risk by two-thirds. In fact, if AF were adequately identified and treated, around 7000 strokes could be prevented every year in England alone, saving approximately 2000 lives (Stroke Association, 2017). AF is greatly associated with heart failure, in part because both conditions have shared mechanisms, leading to neurohormonal and proinflammatory activation, which can induce myocardial inflammation and fibrosis (Staerk et al, 2017). Equally, AF has been shown to be an independent risk factor for cognitive decline and dementia. Symptoms such as palpitations, breathlessness and fatigue affect up to 80% of individuals with AF (Go et al, 2001) and psychological distress is reported in 35%, potentially because of the unpredictable nature of symptoms, or fear of a future thromboembolic event (Walters et al, 2018). Management is complex and attention must be given to the complete patient experience.

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The impact of nurse-led atrial fibrillation clinics on patient and healthcare outcomes: a systematic mixed studies review

Cited by 32 publications

References 38 publications

A nurse‐led atrial fibrillation clinic: Impact on anticoagulation therapy and clinical outcomes

A nurse‐led atrial fibrillation clinic: Impact on anticoagulation therapy and clinical outcomes

Canada-wide mixed methods analysis evaluating the reasons for inappropriate emergency department presentation in patients with a history of atrial fibrillation: the multicentre AF-ED trial

Global atrial fibrillation awareness week and the new European Society of Cardiology guidelines

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