Anticoagulation in a nurse-led AF-Clinic

Transcription

1 Anticoagulation in a nurse-led AF-Clinic Dr. Jeroen ML Hendriks Maastricht University Medical Centre The Netherlands Department of Cardiology Linköping University - Sweden Department of Medical and Health Sciences Interlaken 13 June 2014

2 Key points to present: The unmet needs in AF-related stroke prevention and anticoagulation prescription Solutions in practice: The AF-Clinic Integrated care and patient-centered approach AF-Clinic Study: demonstrating patient outcomes in stroke prevention 2

3 AF treatment in Europe: Despite guidelines, still a great need to improve AF-related stroke prevention Enrolment per country 5333 patients 35 countries 182 hospitals Euro Heart Survey on Atrial Fibrillation European Society of Cardiology Euro Heart Survey Poor guideline adherence Increased morbidity and mortality Nieuwlaat R et al. Eur Heart J 2005;26:

4 % Patients Euro Heart Suvey Antithrombotics according to CHADS 2 score No antithrombotic drug Other drug only Antiplatelet OAC + antiplatelet OAC only 0 (n=332) 1 (n=697) 2 (n=722) 3 (n=371) 4 (n=172) 5 (n=72) 6 (n=15) Poor adherence to guidelines on management of AF Non-adherence to guidelines increased morbidity/mortality Nieuwlaat R et al. Eur Heart J 2005;26: ; Eur Heart J 2006;26:

5 Solutions in practice: The AF-Clinic Integrated Chronic Care Program Cardiologist 9

6 treatment advice antiarrhythmic drug

7 Integrated chronic care in the AF-Clinic Integrated treatment of a complex disease: Treatment of arrhythmia (rate vs rhythm control) Treatment of CV comorbidity Prevention of thromboembolic complications (Anticoagulation) Lifestyle management Professional relationship nurse and cardiologist: Reciprocal reliance (pilot / co-pilot) Improved communication Guideline adherent management Patient centered approach Patient education Self-management Shared Decision Making 7

8 AF-Clinic: patient education and coordinated care Information and instruction: What is AF? Symptoms Complications Diagnostics Therapeutic options Oral anticoagulation Lifestyle and self-management activities 8

9 Determine AF-related stroke risk 9

10 AF-Clinic: coordinated (anticoagulation) care 10

11 Nurse and Cardiologist Nurse care coordinator 11

12 Stroke prevention and Anticoagulation: Important role of care provider Education is key: up to date knowledge of evidence in AF management Promote adherent behaviour as per guidelines Invite patient for active participation Interactive relationship with the patient Integrated Care AND Coordinated Care in AF 12

13 The AF-Clinic study Hendriks JM et al. Eur Heart J 2012;33:

14 Methods PROBE: Prospective, Randomized, Open label, Blinded Endpoint trial, comparing the AF-Clinic to usual care Randomization of 712 patients with newly diagnosed AF into nurse-led care group or usual care group Inclusion criteria - Age 18 years - AF documented on ECG Exclusion criteria - Unsatisfactorily treated comorbidity Follow-up at least 1 year Primary endpoint: composite of death from CV causes and CV hospitalization; guideline adherence 14

15 Integrated approach improves guideline adherence Hendriks JM et al. Eur Heart J 2012;33:

16 Cumulative incidence of composite endpoint (%) Integrated approach: reduction in CV hospitalization and CV death Usual care Nurse-led care % RRR P < Months of observation Hendriks JM et al. Eur Heart J 2012;33:

17 Results: composite endpoint Endpoint Nurse-led care n (%) Usual care n (%) HR (95% CI) P value Composite 51 (14.3) 74 (20.8) 0.65 ( ) CV hospitalization 48 (13.5) 68 (19.1) 0.66 ( ) CV death 4 (1.1) 14 (3.9) 0.28 ( ) CV = cardiovascular Hendriks JM et al. Eur Heart J 2012;33:2692 9

18 In summary: a nurse-led AF-Clinic can... Promote improved anticoagulation guideline adherence Protect patients from incomplete diagnostic and therapeutic procedures Prevent (thromboembolic) complications, hospitalization and death Promote an interactive partnership between cardiologist, nurse AND patient Create possibilities for activation of self-management behavior and shared decision making in anticoagulation Coordinated care in anticoagulation is essential to support effective AF-related stroke prevention 18

19 THANK YOU