Integrale zorg voor patiënten met atriumfibrilleren*

Aims

To evaluate whether integrated care for atrial fibrillation (AF) can be safely orchestrated in primary care.

Methods and Results

The ALL-IN trial was a cluster randomised, open-label, pragmatic non-inferiority trial performed in primary care practices in the Netherlands. We randomised 26 practices: 15 to the integrated care intervention and 11 to usual care. The integrated care intervention consisted of (i) quarterly AF check-ups by trained nurses in primary care, also focusing on possibly interfering comorbidities, (ii) monitoring of anticoagulation therapy in primary care, and finally (iii) easy-access availability of consultations from cardiologists and anticoagulation clinics. The primary endpoint was all-cause mortality during 2 years of follow-up. In the intervention arm, 527 out of 941 eligible AF patients aged ≥ 65 years provided informed consent to undergo the intervention. These 527 patients were compared with 713 AF patients in the control arm receiving usual care. Median age was 77 (interquartile range 72-83) years. The all-cause mortality rate was 3.5 per 100 patient-years in the intervention arm versus 6.7 per 100 patient-years in the control arm (adjusted hazard ratio 0.55; 95% confidence interval (CI) 0.37 to 0.82). For non-cardiovascular mortality, the adjusted hazard ratio was 0.47 (95% CI 0.27 to 0.82). For other adverse events no statistically significant differences were observed.

Conclusion

In this cluster randomised trial, integrated care for elderly AF patients in primary care showed a 45% reduction in all-cause mortality when compared to usual care.

Conflict of interest and financial support: none declared.