Background: Atrial fibrillation is globally the most common sustained cardiac arrhythmia which increases patient morbidity and mortality, dramatically influencing well-being. Despite substantial efforts, an optimal clinical pathway for chronic atrial fibrillation management has yet to be developed. In recent practice, a multidisciplinary team management has been recommended for patients with atrial fibrillation. However, experiments exploring nurse-led multidisciplinary team management in chronic atrial fibrillation management relative to standard clinical management are still sparse and limited.
Objective: To evaluate the effects of a nurse-led multidisciplinary team approach on cardiovascular hospitalization and death, and quality of life in patients with atrial fibrillation.
Design: Randomized controlled trial.
Setting: The Cardiology Department of a tertiary referral hospital in Beijing, China.
Participants: Eligible patients diagnosed with atrial fibrillation who consented.
Methods: Subjects were randomly assigned into one of two Cardiology Units upon admission. Patients in the control group (n = 119) received usual care and those in the intervention group (n = 116) underwent a nurse-led multidisciplinary team approach. Follow-up lasted for 12 months. The primary endpoint was a composite of cardiovascular hospitalization and cardiovascular death. The secondary endpoint was the differences in the quality of life between the groups observed at 6 months and 12 months of follow-up, compared to the baseline data, as determined using a Chinese version of the Medical Outcome Study Short-Form 36 General Health Survey.
Results: Patients under intervention showed a fewer cardiovascular hospitalization (17 vs. 35, p = 0.006) than those receiving usual care. Discernible differences were also observed in rates of cardiovascular hospitalization between the two groups (hazard ratio: 2.115, 95% confidential interval: 1.228-3.643, log-rank = 6.746, p = 0.009). Quality of life was improved in both groups, but more so in the intervention group (scores, 588.0 ± 106.0 vs. 519.1 ± 120.7 at 6 months and 674.4 ± 53.4 vs. 584.1 ± 105.9 at 12 months; both p < 0.001). Repeated measures analysis of variance indicated that group-by-time and between-subjects effects in respect of patients' quality of life (F = 9.310, p < 0.01; F = 29.042, p < 0.01, respectively). No relationships were found with cardiovascular death.
Conclusions: Nurse-led multidisciplinary team management reduces cardiovascular hospitalization and improves quality of life in patients with atrial fibrillation, suggesting that this innovative management approach should be implemented in clinical practice.
Registration number: Chinese Clinical Trial Registry (ChiCTR1800018851).
Keywords: Atrial fibrillation; Hospitalization; Interdisciplinary; Mortality; Nursing care; Quality of life; Randomized controlled trial.
Copyright © 2021. Published by Elsevier Ltd.