Atrial fibrillation: Individualized At-Home Care Reduced Hospital Stays and Prolonged Survival

Prof Simon Stewart PhD Mary MacKillop Institute for Health Research, Australian Catholic University, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Interview with:
Prof Simon Stewart PhD
Mary MacKillop Institute for Health Research, Australian Catholic University,
Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia

Medical Research: What is the background for this study? What are the main findings?

Prof. Stewart: Atrial fibrillation (AF) is the most common irregular heart beat and a major cause of deadly and disabling stroke and chronic heart failure. Atrial fibrillation has become a major public health issue that is putting increasing pressure on health care systems worldwide. In an attempt to reduce re-hospitalisations and death due to Atrial fibrillation, we designed the randomised controlled trial the Standard versus Atrial Fibrillation-spEcific managemenT strategY (SAFETY); a home-based, nurse-led, AF-specific management programme delivered to patients who have been hospitalised with Atrial fibrillation and involved individualised AF management. Half of participants (n=168) were given this intervention and the other half (n=167) underwent standard post-hospital management. All participants were followed-up over 24 months with specific clinic visits scheduled at 12 months and 24 months. We found that patients in the intervention group had proportionately more days alive and out of hospital compared to patients who received standard management (reflecting a combination of less hospital stay and prolonged survival). Further, when intervention patients did go to hospital, the length-of-stay of their admission was shorter than for patients under standard management.

Medical Research: What should clinicians and patients take away from your report?

Prof. Stewart: An Atrial fibrillation-specific management programme delivered at home can improve the longer term health of patients who have been hospitalised with Atrial fibrillation. More specifically, this programme can keep patients alive and out of hospital for longer than patients who undergo standard health care. Therefore, this strategy of disease-specific management has the potential to improve the health of an increasing number of patients with chronic AF who commonly experience recurrent hospitalisations and premature death.

Medical Research: What recommendations do you have for future research as a result of this study?

Prof. Stewart: Firstly, a comprehensive economic analysis is required to understand if this model of care is affordable. Follow-up studies are required to confirm significant differences (relative to standard care) in respect to reduced hospital stay and prolonged survival as individual outcomes. Further research is also needed to more extensively understand which specific groups of patients (e.g. men or women, younger or older) are most likely to benefit from this management programme. We also need to analyse all cardiovascular events to understand how specific improvements to management can be made.

Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial
Prof Simon Stewart PhD,Jocasta Ball PhD,Prof John D Horowitz PhD,Prof Thomas H Marwick PhD,Gnanadevan Mahadevan FRACP,Chiew Wong PhD,Prof Walter P Abhayaratna PhD,Yih K Chan PhD,Prof Adrian Esterman PhD,Prof David R Thompson PhD,Prof Paul A Scuffham PhD,Melinda J Carrington PhD
The Lancet – 17 November 2014
DOI: 10.1016/S0140-6736(14)61992-9