Management of atrial fibrillation in primary care setting, the ALL-IN trial

Author: Dr Patricia Ding

Transcript:

Dr Warwick Jaffe:

Patricia, can you tell me the trial was about?

Dr Patricia Ding:

Right, so this is a trial called ALL-In trial conducted in Netherlands, involving 26 GP practices. They cluster randomized them to the integrated care group versus the usual care group. There were about 1,200 patients with 500 also in the international group, and 700 in the usual care group.

Dr Warwick Jaffe:

When these patients came to the general practice, what did the nurses actually do? What was actually done to improve them and monitor them?

Dr Patricia Ding:

So the main intervention provided to the integrated care group was a practice nurse was trained for three hours at the beginning of the trial, in terms of being able to recognize early signs of heart failure, atrial fibrillation, rate control, INR monitoring, renal function monitoring in those who are on novel oral anticoagulants, recognizing some other comorbidities, and early access with cardiologists for advice. This care are provided quarterly for those patients.

Dr Warwick Jaffe:

What did they find? What were the results of the trial?

Dr Patricia Ding:

The main finding was quite interesting that at the primary end point was all-cause mortality. It was found there's a 45% reduction in all-cause mortality in the integrated care group, which is quite significant.

Dr Warwick Jaffe:

Yeah, that's a huge benefit to the patients. Well, do you think we can apply these findings to New Zealand patients? I mean, this was done in older Dutch patients, I understand.

Dr Patricia Ding:

Yeah, absolutely. I think it's a very easily implemented care for these elderly patients to have a practice nurse to check on them every three months in terms of mainly detecting early signs of heart failure, and giving them some education about what are the other aspects of atrial fibrillation, able to recognize ECG changes. The bottom line is these people should be having early access, easy access to specialist care when they need to. That really reduced the need of going into the hospital acutely with AF-related heart failure and improved their survival rate.

Dr Warwick Jaffe:

Well, thank you Patricia. On our website, if you click on the link, you'll see the actual things that the nurses were measuring and perhaps a plan that if you wish to use this in your practice, you can follow. Thank you again, Patricia.

Dr Patricia Ding:

Thank you, Warwick.

 

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