Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial
| Autor: | Walter P. Abhayaratna, Thomas H. Marwick, Melinda Carrington, Gnanadevan Mahadevan, Adrian Esterman, Simon Stewart, Paul Anthony Scuffham, Yih K Chan, Chiew Wong, John D. Horowitz, David R. Thompson, Jocasta Ball |
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| Přispěvatelé: | Stewart, Simon, Ball, Jocasta, Horowitz, John D, Marwick, Thomas H, Mahadevan, Gnanadevan, Wong, Chiew, Abhayaratna, Walter P, Chan, Yih K, Esterman, Adrian Jeffrey, Thompson, David R, Scuffham, Paul A, Carrington, Melinda J |
| Rok vydání: | 2015 |
| Předmět: |
Male
management strategy Pediatrics medicine.medical_specialty Referral Kaplan-Meier Estimate Patient Readmission law.invention Quality of life Randomized controlled trial Risk Factors law Atrial Fibrillation Secondary Prevention medicine Humans atrial fibrillation Prospective Studies Prospective cohort study Aged Patient Care Team business.industry Hazard ratio Atrial fibrillation General Medicine Length of Stay medicine.disease Home Care Services Clinical trial Treatment Outcome Heart failure Chronic Disease Emergency medicine Electrocardiography Ambulatory Quality of Life Female disease-specific management business |
| Zdroj: | The Lancet. 385:775-784 |
| ISSN: | 0140-6736 |
| Popis: | Summary Background Patients are increasingly being admitted with chronic atrial fibrillation, and disease-specific management might reduce recurrent admissions and prolong survival. However, evidence is scant to support the application of this therapeutic approach. We aimed to assess SAFETY—a management strategy that is specific to atrial fibrillation. Methods We did a pragmatic, multicentre, randomised controlled trial in patients admitted with chronic, non-valvular atrial fibrillation (but not heart failure). Patients were recruited from three tertiary referral hospitals in Australia. 335 participants were randomly assigned by computer-generated schedule (stratified for rhythm or rate control) to either standard management (n=167) or the SAFETY intervention (n=168). Standard management consisted of routine primary care and hospital outpatient follow-up. The SAFETY intervention comprised a home visit and Holter monitoring 7–14 days after discharge by a cardiac nurse with prolonged follow-up and multidisciplinary support as needed. Clinical reviews were undertaken at 12 and 24 months (minimum follow-up). Coprimary outcomes were death or unplanned readmission (both all-cause), measured as event-free survival and the proportion of actual versus maximum days alive and out of hospital. Analyses were done on an intention-to-treat basis. The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTRN 12610000221055). Findings During median follow-up of 905 days (IQR 773–1050), 49 people died and 987 unplanned admissions were recorded (totalling 5530 days in hospital). 127 (76%) patients assigned to the SAFETY intervention died or had an unplanned readmission (median event-free survival 183 days [IQR 116–409]) and 137 (82%) people allocated standard management achieved a coprimary outcome (199 days [116–249]; hazard ratio 0·97, 95% CI 0·76–1·23; p=0·851). Patients assigned to the SAFETY intervention had 99·5% maximum event-free days (95% CI 99·3–99·7), equating to a median of 900 (IQR 767–1025) of 937 maximum days alive and out of hospital. By comparison, those allocated to standard management had 99·2% (95% CI 98·8–99·4) maximum event-free days, equating to a median of 860 (IQR 752–1047) of 937 maximum days alive and out of hospital (effect size 0·22, 95% CI 0·21–0·23; p=0·039). Interpretation A post-discharge management programme specific to atrial fibrillation was associated with proportionately more days alive and out of hospital (but not prolonged event-free survival) relative to standard management. Disease-specific management is a possible strategy to improve poor health outcomes in patients admitted with chronic atrial fibrillation. Funding National Health and Medical Research Council of Australia. |
| Databáze: | OpenAIRE |
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