Delesie, Michiel

Abstract: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and creates a significant burden on patients, physicians and healthcare systems. To reduce the AF burden by delivering optimized AF care, AF guidelines propose a patient-centered, multidisciplinary and structured integrated care approach. This integrated AF care concept consists of different components, but it remains unknown which elements are beneficial or may be redundant. In addition, several elements of the integrated AF care concept itself contain specific knowledge gaps. Firstly, the ongoing AF-EduCare study is introduced, which is a large multicenter randomized clinical trial based on the integrated AF care model consisting of (i) targeted AF education, (ii) improving patients\u2019 lifestyle, (iii) optimizing adherence to oral anticoagulants (OAC) and (iv) continuity of care for AF patients in case of AF related problems. The main aim of this trial is to improve several (clinical) outcomes for AF patients. The characteristics of the assessed AF population for this study (n=1232) and its eventual participants are also discussed, providing insights in the current AF management in Flanders. In contrast to prior integrated AF trials, the AF-EduCare study incorporates all types of AF patients. In the second part, specific building blocks of the integrated AF care model were further investigated. Appropriateness of non-vitamin K antagonist oral anticoagulants (NOAC) dosing in ambulatory care was assessed. This study found a relatively high proportion of AF patients receiving an inappropriate NOAC dose according to different NOAC dosing algorithms. Furthermore, an electronic medication event monitoring system (MEMS) for optimizing OAC adherence is investigated in the AF-EduCare study. A first analysis showed a high mean adherence >90% for all OAC therapy. Future results and additional analysis will provide more insights into the use of the MEMS and its influence on improving adherence to OAC therapy. Tools for the detection of obstructive sleep apnea (OSA), a highly underrecognized AF risk factor, were evaluated as screening options in AF patients. The use of OSA screening questionnaires/scoring systems for the detection of clinically relevant OSA was highly questionable, but polygraphy devices combined with an automated algorithm can be used as reliable OSA detection tools in selected AF patients. Lastly, motivation for weight reduction in overweight AF patients and associated factors were investigated. One-third of the participants did not realize that being overweight is an AF risk factor. Tailored (home-based) weight reduction programs should be developed and validated to address this prevalent AF risk factor. In conclusion, the results of these investigated components contribute to the optimization of integrated AF management. In addition, based on the future outcome results of our large AF-EduCare trial, we can hopefully obtain an effective blueprint for a structured AF care approach and add extra evidence to the integrated AF concept

Integrated management of patients with atrial fibrillation : full care pathway and insights in several of its components

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