Integrated care for atrial fibrillation: the heart of the matter
Celine Gallagher, Jeroen Hendriks, Karin Nyfort‐Hansen, Prashanthan Sanders, Dennis H. Lau
Abstract
The global burden of atrial fibrillation (AF) is continuing to rise and the economic impact, largely driven by increasing hospitalizations is significant; with AF hospitalizations now outnumbering those for heart failure and myocardial infarction.1 Despite advances in our understanding of the complex pathophysiologic mechanisms underlying AF, current pharmacological and catheter-based approaches to manage this arrhythmia remain suboptimal.2 As such, new approaches to improve management of AF and its associated conditions are urgently needed. The integrated care approach is one that has been highlighted in several studies over the last decade.3–7 Integrated patient care has been defined as care that is (i) coordinated across professionals, facilities, and support systems; (ii) continuous over time and between visits; (iii) tailored to the patient’s needs and preferences; and (iv) based on shared responsibility between patients and caregivers for optimizing health.8 Specific to AF, the four key elements of integrated patient care include: delivery of patient-centred care with an active role for the patient; a multidisciplinary team approach; the use of e-health to support patients and health care providers; and a comprehensive treatment approach that includes a full suite of options for managing AF and associated conditions (Figure 1).9 The effectiveness and role of these novel models of coordinated care delivery in AF remain unclear due to the mixed results reported to date.3–7 It is therefore timely to further examine these studies regarding their delivery of the integrated care components (Table 1).