Miguel Rivera-Caravaca, Jose, Gil-Perez, Pablo, Lopez-Garcia, Cecilia, Veliz-Martinez, Andrea, Quintana-Giner, Miriam, Isabel Romero-Aniorte, Ana, Fernandez-Redondo, Concepcion, Munoz, Luis, Quero, Eva, Esteve-Pastor, Maria Asuncion et al (show 3 more authors)
(2020)
A nurse-led atrial fibrillation clinic: Impact on anticoagulation therapy and clinical outcomes.
INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, 74 (12).
e13634-.
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Abstract
<h4>Background</h4>Nurses play a central role in the management of atrial fibrillation (AF) patients. An unresolved question is whether a nurse-led clinic would improve clinical outcomes. Herein, we investigated the impact of a nurse-led clinic on anticoagulation therapy and clinical outcomes in a cohort of naïve AF patients.<h4>Methods</h4>Prospective study including AF patients starting vitamin K antagonists (VKAs) into a nurse-led AF clinic. These patients were followed in this specific AF clinic. Additionally, AF patients already taking VKAs for 6 months followed according to the routine clinical practice were included as comparison group. The quality of anticoagulation was assessed at 6 months. Efficacy and safety endpoints were recorded during follow-up.<h4>Results</h4>We included 223 patients (Nurse-led clinic: 107; Usual care: 116). The mean time in therapeutic range and the proportion of INRs within the therapeutic range were similar in both groups. During 2.06 (IQR 1.01-2.94) years of follow-up, 64 (28.7%) patients changed to direct-acting oral anticoagulants. The proportion of switchers was higher in the nurse-led clinic (37.4%) than in the usual care group (20.7%) (P = .006) and these patients spent less time to switch (2.0 [IQR 0.7-2.9] vs 6.0 [IQR 3.7-11.2] years; P < .001). Importantly, the annual rate of ischaemic stroke/TIA was significantly lower in the nurse-led clinic (0.47%/year vs 3.88%/year, P = .016), without differences in safety endpoints.<h4>Conclusion</h4>A nurse-led AF clinic may offer a "patient-centered" review and holistic follow-up, and it would be associated with a reduction of ischaemic stroke/TIA, without increasing bleeding complications. Further studies should confirm these results.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Brain Ischemia, Atrial Fibrillation, Vitamin K, Anticoagulants, Administration, Oral, Prospective Studies, Stroke |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 29 Sep 2020 10:40 |
| Last Modified: | 18 Jan 2023 23:31 |
| DOI: | 10.1111/ijcp.13634 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3102974 |
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