Cardiovascular health, heart disease
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A patient questionnaire was used to help design a new software tool to improve management of elderly atrial fibrillation patients with multiple conditions. The investigators defined 22 comorbidities that are common in these patients and then created concise care pathways to guide effective management of certain types of patients. The software will next be tested in a large clinical trial.

The tool was devised by the European Heart Rhythm (EHRA)-PATHS consortium. And is being presented this week at EHRA 2023, a scientific congress of the European Society of Cardiology. Hein Heidbuchel is scientific coordinator of the project.

Atrial fibrillation is the most common heart rhythm disorder.  It is estimated that 6-12 million people in the U.S. and 17.9 million in Europe will experience this condition by 2060.  Patients with atrial fibrillation have an average of five co-existing conditions including high blood pressure, coronary artery disease, heart failure, obesity and chronic kidney disease. In addition, three-quarters of atrial fibrillation patients take at least five medications.

EHRA-PATHS is an international project to provide integrated care for patients with atrial fibrillation and at least one additional chronic condition. Previously, the group’s survey of healthcare professionals reported that the lack of an integrated care model was hindering referrals to specialist services for atrial fibrillation comorbidities.

Results of patient interviews also highlighted the need for integrated care and interprofessional collaboration when treating these patients. The interviews included thirty atrial fibrillation patients with two or more additional conditions from Belgium, Greece, Poland, Spain, and the Netherlands. The average age was 73 years and 37% were women.

The most common comorbidity was high blood pressure, followed by high cholesterol, obesity, hypothyroidism, and diabetes. Interviewees reported having multiple appointments at different locations. While respondents had some knowledge about the relationship between comorbidities and atrial fibrillation and were motivated to make adjustments, they lacked formal education on how to implement and maintain lifestyle changes.

The EHRA-PATHS care pathways are now being integrated in a software tool that will assist healthcare personnel in evaluating these patients. “This is the cornerstone of the overall aim of the project, which is to improve outcomes of patients with atrial fibrillation by systematic detection and management of underlying conditions, and by multidisciplinary referral or collaboration where needed,” said Heidbuchel.

The software will next be evaluated in a clinical study involving 65 hospitals in 14 European countries. To establish a baseline picture, in part one of the study, researchers will evaluate the management (assessment and treatment) of risk factors and comorbidities in approximately 1,300 patients aged 65 years and older with newly diagnosed atrial fibrillation. Part two will be a randomized controlled trial in 1,080 patients assessing whether allocation to the software tool improves management of atrial fibrillation compared with usual care.

The trial will focus on 12 comorbidities: hypertension, hyperlipidemia, heart failure, overweight/obesity, renal insufficiency, smoking, diabetes, coronary heart disease, valvular disease, physical activity, chronic obstructive pulmonary disease/asthma and alcohol consumption.

The primary endpoint is the number of risk factors and comorbidities that are identified and for which treatment is initiated during base mapping (part one) and at the end of the randomized controlled trial (part two). Secondary endpoints include atrial fibrillation symptom burden, quality of life, patient and healthcare professional satisfaction, referrals to other disciplines, and cost-effectiveness.

Heidbuchel said If the project succeeds,” it will have delivered a tool to the medical community to improve atrial fibrillation management, and to make it more uniform all over Europe and beyond.”

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