title: Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation.
abstract: OBJECTIVE
  The management of patients with atrial fibrillation (AF) is often inadequate due to deficient adherence to the guidelines. A nurse-led AF clinic providing integrated chronic care to improve guideline adherence and activate patients in their role, may effectively reduce morbidity and mortality but such care has not been tested in a large randomized trial. Therefore, we performed a randomized clinical trial to compare the AF clinic with routine clinical care in patients with AF.
  
  
  RESULTS
  We randomly assigned 712 patients with AF to nurse-led care and usual care. Nurse-led care consisted of guidelines based, software supported integrated chronic care supervised by a cardiologist. The primary endpoint was a composite of cardiovascular hospitalization and cardiovascular death. Duration of follow-up was at least 12 months. Adherence to guideline recommendations was significantly better in the nurse-led care group. After a mean of 22 months, the primary endpoint occurred in 14.3% of 356 patients of the nurse-led care group compared with 20.8% of 356 patients receiving usual care [hazard ratio: 0.65; 95% confidence interval (CI) 0.45-0.93; P= 0.017]. Cardiovascular death occurred in 1.1% in the nurse-led care vs. 3.9% in the usual care group (hazard ratio: 0.28; 95% CI: 0.09-0.85; P= 0.025). Cardiovascular hospitalization amounted (13.5 vs. 19.1%, respectively, hazard ratio: 0.66; 95% CI: 0.46-0.96, P= 0.029).
  
  
  CONCLUSIONS
  Nurse-led care of patients with AF is superior to usual care provided by a cardiologist in terms of cardiovascular hospitalizations and cardiovascular mortality. Trial registration information: Clinicaltrials.gov identifier number: NCT00391872.
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. jeroen.hendriks@maastrichtuniversity.nl
authors.forename: Jeroen M L
authors.initials: JM
authors.lastname: Hendriks
authors.forename: Rianne
authors.initials: R
authors.lastname: de Wit
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
authors.forename: Hubertus J M
authors.initials: HJ
authors.lastname: Vrijhoef
authors.forename: Martin H
authors.initials: MH
authors.lastname: Prins
authors.forename: Ron
authors.initials: R
authors.lastname: Pisters
authors.forename: Laurent A F G
authors.initials: LA
authors.lastname: Pison
authors.forename: Yuri
authors.initials: Y
authors.lastname: Blaauw
authors.forename: Robert G
authors.initials: RG
authors.lastname: Tieleman
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D001281:Atrial Fibrillation / Q000401:mortality / Q000451:nursing / Q000628:therapy*; D019033:Delivery of Health Care, Integrated; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009426:Netherlands; D057184:Practice Patterns, Nurses'; D016016:Proportional Hazards Models; D016896:Treatment Outcome