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Bringing order to chaos: the case for integrated management of atrial fibrillation
  1. Simon Stewart
  1. Correspondence to Professor Simon Stewart, Mary MacKillop Institute for Health Research, NHMRC Centre of Research Excellence in Health Service Research to Reduce Inequality in Heart Disease, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia; simon.stewart{at}acu.edu.au

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Over the past 20 to 30 years, the epidemiological burden of cardiovascular disease in high-income countries has transformed from a predominance of acute ischaemic events in middle-aged men to chronic forms of heart disease equally affecting both sexes. The first wave of epidemiological change saw the emergence of heart failure (HF) as a substantive public health issue.1 Beyond pharmacological agents and devices, a large body of evidence now supports the application of predominantly nurse-led, multidisciplinary management programmes to address high levels of morbidity and mortality in that patient population; with home-based models of care seemingly more effective than other modes in delivering what are essentially the same components of care.2 The second wave of epidemiological change (reflecting subtle but important differences in the natural history of HF and atrial fibrillation (AF)) saw the emergence of AF as a compounding burden of disease within our ageing populations.3 Often characterised as a ‘one in a hundred’ condition, contemporary epidemiological reports show that the incidence of AF (in all its forms) is increasing and its population prevalence ranges from 2.3%–3.4% with a marked gradient in cases according to age.3 It is on this basis that 10%–20% of individuals aged >65 years develop AF with a lifetime risk of one in four. Primary care contacts and hospitalisations attributable to AF (both as a primary and secondary cause) are on the rise and its individual to societal burden is substantive.3 A …

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