Atrial Fibrillation-Specific Follow-up Plan Improves Post-Discharge Survivability

Research shows that a follow-up strategy designed specifically for patients who visit the hospital with atrial fibrillation (AF) reduces future admissions and patient deaths more than a general follow-up plan.

The authors of the paper, which just appeared in The Lancet, performed a randomized controlled trial in patients admitted to 3 Australian hospitals with chronic, non-valvular AF (but no heart failure).

A computer-generated schedule, which was stratified for rhythm control or rate control, randomly assigned 167 patients to standard management and 168 patients to the AF-specific program.

Standard management was just what it sounds like: routine primary care and follow-up from the hospital. The AF-specific program entailed “a home visit and Holter monitoring 7-14 days after discharge by a cardiac nurse with prolonged follow-up and multidisciplinary support as needed.”

The researchers undertook clinical reviews at 12 and 24 months. The primary outcomes were death or unplanned readmission from any cause.

After a median follow-up of 905 days, 137 (82%) of the patients in the control group — but only 127 (76%) patients assigned to the AF-specific intervention — died or returned to the hospital for an unplanned admission.

Patients who received specialized follow-up were collectively alive and out of the hospital for146,967 of a possible 159,133 days (92%), which equated to a per-person median 900 of 937 possible days. Patients who received standardized follow-up were collectively alive and out of the hospital for 141,133 of 158,466 days (89%), which equated to a per-person median of 860 out of 937 possible days.

The difference, though small, was significant. The effect size was 0.39 (95% confidence interval [CI] 0.38-0.41; p=0.250).

There was not, however, any significant difference in prolonged event-free survival between the groups.

At 12 months of follow-up, more participants in the specialized-care group achieved higher median event-free survival, but the reverse was true at 24 months, and there was no significant difference overall.

Specifically, median event-free survival was 183 days for patients who received specialized care (interquartile range [IQR]116 days — 409 days) and 199 days for patients who received standard care (IQR 116 days – 249 days). The calculated hazard ratio for specialized care on that endpoint was 0.97 (95% CI 0.76—1.23; p=0.851).

The authors of the study believe their work helps to fill a significant gap in existing research.

“Patients are increasingly being admitted with chronic atrial fibrillation, and disease-specific management might reduce recurrent admissions and prolong survival. However,” they wrote, “evidence is scant to support the application of this therapeutic approach.”

This study, the authors conclude, provides significant evidence in support of specialized follow-up therapy.

“A post-discharge management programme specific to atrial fibrillation was associated with proportionately more days alive and out of hospital (but not prolonged event-free survival) relative to standard management,” they wrote.

“Disease-specific management is a possible strategy to improve poor health outcomes in patients admitted with chronic atrial fibrillation.”

Funding for the study was provided by the National Health and Medical Research Council of Australia. The study authors did not disclose any conflicts of interest.