Up to as much as 45 percent fewer people died - this is one of the outcomes of a study into comprehensive care for atrial fibrillation patients.Research physician and general practice PhD candidate Carline van den Dries of UMC Utrecht talks about the study design, execution and results.

Atrial fibrillation is the most common arrhythmia disorder in the Netherlands. "It is a disorder with a high degree of co-morbidity. That means that patients often also have other health problems, such as hypertension, diabetes or COPD," says Carline. According to the research physician, atrial fibrillation in itself is not fatal. "But it can lead to a cerebral infarction or heart failure, which could result in death."
Carline and her colleagues conducted a study of comprehensive care for atrial fibrillation patients. These people often have multiple healthcare providers, including a cardiologist, thrombosis clinic and general practitioner. "This may lead to fragmented care, which is why we thought comprehensive care could have a favorable effect."

A single point of contact
Is safe comprehensive care for atrial fibrillation patients in general practices possible? That is the research question of the ALL-IN study that Carline started at the UMC Utrecht's Julius Center in 2015. She found 26 general practices in the Zwolle, Hardenberg and Deventer region that were willing to participate in the study. Fifteen introduced the new method of comprehensive care in the study, while eleven control practices continued with their existing methods. Only patients aged 65 and over participated. "In the end, 527 of the 1,240 patients received comprehensive care and 713 patients received regular care."

Comprehensive care consisted of three elements. First of all, the patients were give a general check-up by their general practitioner every three months, says Carline.
For the second element, their anticoagulation medication check-up, patients also went to their GP. "Normally speaking, they would go to the thrombosis clinic for this. The benefit of going to the GP is that patients receive care closer to home as well as seeing the same healthcare provider more often. That way, they have a single point of contact."
Finally, the study aimed at close cooperation between primary and secondary care. "GPs and practice nurses had short lines of communications with the thrombosis clinic and cardiologists. That way, they could be brought in more quickly if necessary, while primary care professionals and patients could still benefit from their knowledge."

The outcomes
After two years, Carline started analyzing the data. "The study was intended to check whether comprehensive care can be given safely in GP practices. We hoped it would at least not increase mortality. But what we found is that up to 45 percent fewer people died. That is a fantastic outcome. But, as scientists, we have to consider outcomes like this with due care: we also want to know whether the result will be the same for other practices and why it works so well. This means we need more studies."
 Another notable outcome according to Carline: most patients in the study who died, did not die of a heart-related problem. "This confirms the idea that atrial fibrillation is not purely a heart rhythm disorder. It could be a manifestation of other aging processes in the body." Carline thinks that, because the patients were checked frequently and these check-ups looked at the patient's health as a whole, a lot of complications have been prevented.

What's next
The study results were published in the European Heart Journal on March 1. "I hope this method will find application at national level, so that general practices will have a better understanding of atrial fibrillation patients."