AbstractsMedical & Health Science

Optimising the management of patients with atrial fibrillation

by Jocasta Clare Ball

Institution: Monash University
Department: Department of Epidemiology and Preventative Medicine (Baker IDI Heart & Diabetes Institute)
Year: 2014
Keywords: Atrial fibrillation; Epidemiology; Disease management; Risk delineation
Record ID: 1051492
Full text PDF: http://arrow.monash.edu.au/hdl/1959.1/929903


Background: Atrial fibrillation (AF) is the most common form of cardiac arrhythmia found in clinical practice and indeed the adult population. Although AF can present in an acute and non-sustained (paroxysmal AF) form, it typically progresses into a chronic and often silent disorder. Over a prolonged period, chronic AF is associated with detrimental mechanical changes that result in progressive cardiac dysfunction. An enhanced thrombo-embolic state coupled with blood stasis in the atria leads to increased thrombus formation. Consequently, AF is closely linked to thromboembolic stroke and chronic heart failure; two of the most deadly and disabling forms of cardiovascular disease. Chronic AF is, therefore, commonly associated with recurrent hospitalisations and poor patient outcomes overall; including a poor prognosis. Overall, despite the known risks, health outcomes associated with AF continue to be sub-optimal within the context of predominantly older patients who require a careful assessment of risk and individualised management to ensure the benefit-to-risk ratio of often complex therapeutic regimes are optimised. Aims: In addition to understanding the true extent of the global burden of AF, the primary aim of this research was to establish enhanced and potentially effective methods for the assessment of risk in order to direct more individualised AF patient management in an attempt to improve outcomes. More specifically, the influence of gender, mild cognitive impairment and effective rate/rhythm control on patients with AF and as methods for risk delineation was assessed. Methods: The framework for this research was the Standard versus Atrial Fibrillation spEcific managemenT studY (SAFETY), a multi-centre randomised controlled trial of a nurse-led AF-specific intervention involving home-based assessment, extensive risk profiling (over and above conventional profiling) and individualised management compared to usual post-discharge care. Participants included were those > 45 years of age with documented chronic AF for which this has been the cause of hospitalisation. For this research program, quantitative analysis to assess risk delineation strategies was undertaken using data collected at the baseline time point. Results: In a comprehensive review and meta-analyses of the literature, the prevalence of AF was found to be greater than commonly reported. Here, the population prevalence was found to be between 2.5% and 3.5%, substantially higher than the reported 1.0% to 2.0%. Furthermore, the economic consequences were found to be equally as large, with up to 2.5% of health care costs in Europe, North America and Australia spent on AF alone. When a detailed evaluation of gender differences was undertaken, key differences in the clinical presentation, thrombo-embolic risk and therapeutic management of women compared to men were detected. Most importantly, women were, on average, older than their male counterparts and were also more likely to report depressive symptoms and have poorer quality of life. There were also…