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Original research article
Integrated care in atrial fibrillation: a systematic review and meta-analysis
  1. Celine Gallagher,
  2. Adrian D Elliott,
  3. Christopher X Wong,
  4. Geetanjali Rangnekar,
  5. Melissa E Middeldorp,
  6. Rajiv Mahajan,
  7. Dennis H Lau,
  8. Prashanthan Sanders,
  9. Jeroen M L Hendriks
  1. Centre for Heart Rhythm Disorders, University of Adelaide, South Australian Health and Medical Research Institute and Royal Adelaide Hospital, Adelaide, Australia
  1. Correspondence to Dr Jeroen ML Hendriks, Centre for Heart Rhythm Disorders, Department of Cardiology, Royal Adelaide Hospital, Adelaide SA 5000, Australia; jeroen.hendriks{at}adelaide.edu.au

Abstract

Objective Atrial fibrillation (AF) is an emerging global epidemic associated with significant morbidity and mortality. Whilst other chronic cardiovascular conditions have demonstrated enhanced patient outcomes from coordinated systems of care, the use of this approach in AF is a comparatively new concept. Recent evidence has suggested that the integrated care approach may be of benefit in the AF population, yet has not been widely implemented in routine clinical practice. We sought to undertake a systematic review and meta-analysis to evaluate the impact of integrated care approaches to care delivery in the AF population on outcomes including mortality, hospitalisations, emergency department visits, cerebrovascular events and patient-reported outcomes.

Methods PubMed, Embase and CINAHL databases were searched until February 2016 to identify papers addressing the impact of integrated care in the AF population. Three studies, with a total study population of 1383, were identified that compared integrated care approaches with usual care in AF populations.

Results Use of this approach was associated with a reduction in all-cause mortality (OR 0.51, 95% CI 0.32 to 0.80, p=0.003) and cardiovascular hospitalisations (OR 0.58, 95% CI 0.44 to 0.77, p=0.0002) but did not significantly impact on AF-related hospitalisations (OR 0.82, 95% CI 0.56 to 1.19, p=0.29) or cerebrovascular events (OR 1.00, 95% CI 0.48 to 2.09, p=1.00).

Conclusions The use of the integrated care approach in AF is associated with reduced cardiovascular hospitalisations and all-cause mortality. Further research is needed to identify optimal settings, methods and components of delivering integrated care to the burgeoning AF population.

  • integrated care
  • atrial fibrillation
  • outcomes
  • systematic review
  • meta-analysis

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Footnotes

  • Contributors CG, JH and PS had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: CG, JH and PS. Acquisition of data: CG and JH. Analysis and interpretation of data: CG, JH, AE, DL and PS. Drafting of the manuscript: CG, JH and PS. Critical revision of the manuscript for important intellectual content: CG, JH, AE, CXW, GR, MM, RM, DL and PS. Statistical analysis: CG and AE. Administrative, technical or material support: CG, JH, AE, CXW, GR, MM and RM. Study supervision: JH, CXW, DL and PS.

  • Competing interests None declared.

  • Patient consent This manuscript contains a systematic review. Consent and ethics procedures have been undertaken in the original studies.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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