The Education and Communication Pillars of Integrated Care for Atrial Fibrillation.

The prevalence of atrial fibrillation (AF) is high and is still rising. This arrhythmia is associated with increased morbidity, mortality and a high healthcare burden. As stated in the 2016 European Guidelines on the management of AF, there is an urgent need for a more structured and efficient care system for these patients in order to reduce the burden on this population, the society, the healthcare system and the economy.

A proposed strategy is to deliver care through ‘interdisciplinary nurse-led AF centers’, that have shown to improve guideline-adherence and outcomes in a cost-effective way. ‘Integrated care’ requires streamlined communication between stakeholders (cardiologists, general practitioners, other specialists, care givers) on one hand, and improved education of patients on the other hand, to increase their motivation, to empower them for more self-care and to allow shared decision-making. However, there are no blueprints available on how this ‘integrated care’ should be implemented. Hospitals often have no predefined pathways or support systems to evaluate and follow-up AF patients in a systematic way and to communicate their management to different stakeholders. For patient education, a more structured and individualized approach is indispensable.

Our research group has already some insights into the shortcomings in the care for AF patients through several observational studies. The first pilot trials evaluating different strategies to optimize this care were also promising.  

This multicenter project aims to evaluate which elements of integrated care contribute most to improved outcomes and how proven therapies can most efficient and most cost-effectively be delivered to AF patients. We will focus on two main topics: 1) targeted education of patients, aiming for more knowledge increase and better clinical outcomes. 2) improved communication within the AF center, and between the AF center and different stakeholders.  

Finally, we will also evaluate the impact of a self-developed and innovative mobile application in which targeted education will be delivered together with medication adherence strategies on several (clinical) outcomes.

Funding: FWO – TBM project

Collaborating centers:

- UZ Antwerpen / Universiteit Antwerpen

- UZ Leuven / KU Leuven

- Jessa Ziekenhuis Hasselt / Universiteit Hasselt

Principal Investigator: Professor Dr. Hein Heidbuchel

Co-Investigators from other centers: Prof. Dr. Paul Dendale, Dr. Johan Vijgen, Prof. Dr. Joris Ector

Coordinating investigators: Dr. Michiel Delesie, Lien Desteghe