Dataset Information

Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation-REAFEL.

ABSTRACT:

Background

Frail elderly patients are exposed to suffering strokes if they do not receive timely anticoagulation to prevent stroke associated to atrial fibrillation (AF). Evaluation in the cardiological ambulatory can be cumbersome as it often requires repeated visits.

Aim

To develop and implement CardioShare, a shared-care model where primary care leads patient management, using a compact Holter monitor device with asynchronous remote support from cardiologists.

Methods

CardioShare was developed in a feasibility phase, tested in a pragmatic cluster randomization trial (primary care clinics as clusters), and its implementation potential was evaluated with an escalation test. Mixed methods were used to evaluate the impact of this complex intervention, comprising quantitative observations, semi-structured interviews, and workshops.

Results

Between February 2020 and December 2021, 314 patients (30% frail) were included, of whom 75% had AF diagnosed/not found within 13 days; 80% in both groups avoided referral to cardiologists. Patients felt safe and primary care clinicians satisfied. In an escalation test, 58 primary-care doctors evaluated 93 patients over three months, with remote support from four hospitals in the Capital Region of Denmark.

Conclusions

CardioShare was successfully implemented for AF evaluation in primary care.

SUBMITTER: Bamberg C

PROVIDER: S-EPMC10530387 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Publications

Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation-REAFEL.

Bamberg Carsten C Ladegaard Caroline Thorup CT Aalling Mathias M Jensen Dorthea Marie DM Madsen Christoffer Læssøe CL Kamil Sadaf S Gudbergsen Henrik H Saxild Thomas T Schiøtz Michaela Louise ML Grew Julie J Castillo Luana Sandoval LS Tousgaard Iben I Johansen Rie Laurine Rosenthal RLR Bardram Jakob Eyvind JE Frølich Anne A Domínguez Helena H

International journal of environmental research and public health 20230919 18

<h4>Background</h4>Frail elderly patients are exposed to suffering strokes if they do not receive timely anticoagulation to prevent stroke associated to atrial fibrillation (AF). Evaluation in the cardiological ambulatory can be cumbersome as it often requires repeated visits.<h4>Aim</h4>To develop and implement CardioShare, a shared-care model where primary care leads patient management, using a compact Holter monitor device with asynchronous remote support from cardiologists.<h4>Methods</h4>Ca ...[more]

PMID: 37754642

Similar Datasets

Project description:Introduction:Clinical guidelines recommend non-vitamin K antagonist oral anticoagulants (NOACs) over vitamin K antagonists (VKAs) for stroke prevention in most patients with atrial fibrillation (AF). Frail elderly were under-represented in the landmark NOAC-trials, leaving a knowledge gap on the optimal anticoagulant management (VKA or NOAC) in this increasing population. The aim of the Frail-AF (FRAIL-AF) study is to assess whether switching from international normalised ratio (INR)-guided VKA-management to a NOAC-based treatment strategy compared with continuing VKA-management is safe in frail elderly patients with AF.Methods and analysis:The FRAIL-AF study is a pragmatic, multicentre, open-label, randomised controlled clinical trial. Frail elderly (age ≥75 years plus a Groningen Frailty Indicator score ≥3) who receive VKA-treatment for AF in the absence of a mechanical heart valve or severe mitral valve stenosis will be randomised to switch to a NOAC-based treatment strategy or to continue INR-guided VKA-management. Patients with severe renal impairment (estimated glomerular filtration rate <30 mL/min/1.73 m2) will be excluded from randomisation. Based on existing trial evidence in non-frail patients, we will aim to explore whether NOAC-treatment is superior to VKA-therapy in reducing major or clinically relevant non-major bleeding events. Secondary outcomes include minor bleeding, the composite of ischaemic and haemorrhagic stroke, health-related quality of life and cost-effectiveness. The follow-up period for all subjects is 12 months.Ethics and dissemination:The protocol was approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, the Netherlands and by the Central Committee on Research Involving Human Subjects, the Netherlands. All patients are asked written informed consent. Results are expected in 2022 and will be disseminated through peer-reviewed journals as well as presentations at national and international conferences.Trial registration number:EudraCT: 2017-000393-11; The Netherlands Trial Registry: 6721 (FRAIL-AF study).

Dataset Information

Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation-REAFEL.

Background

Aim

Methods

Results

Conclusions

Publications

Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation-REAFEL.

Similar Datasets

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