• Int. J. Clin. Pract. · Dec 2020

    A Nurse-led Atrial Fibrillation Clinic: Impact on Anticoagulation Therapy and Clinical Outcomes.

    • José Miguel Rivera-Caravaca, Pablo Gil-Perez, Cecilia Lopez-García, Andrea Veliz-Martínez, Miriam Quintana-Giner, Ana Isabel Romero-Aniorte, Concepción Fernandez-Redondo, Luis Muñoz, Eva Quero, María Asunción Esteve-Pastor, Lip Gregory Y H GYH https://orcid.org/0000-0002-7566-1626 Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and, Vanessa Roldán, and Francisco Marín.
    • Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), University of Murcia, CIBERCV, Spain.
    • Int. J. Clin. Pract. 2020 Dec 1; 74 (12): e13634.

    BackgroundNurses play a central role in the management of atrial fibrillation (AF) patients. An unresolved question is whether a nurse-led clinic would improve clinical outcomes. Herein, we investigated the impact of a nurse-led clinic on anticoagulation therapy and clinical outcomes in a cohort of naïve AF patients.MethodsProspective study including AF patients starting vitamin K antagonists (VKAs) into a nurse-led AF clinic. These patients were followed in this specific AF clinic. Additionally, AF patients already taking VKAs for 6 months followed according to the routine clinical practice were included as comparison group. The quality of anticoagulation was assessed at 6 months. Efficacy and safety endpoints were recorded during follow-up.ResultsWe included 223 patients (Nurse-led clinic: 107; Usual care: 116). The mean time in therapeutic range and the proportion of INRs within the therapeutic range were similar in both groups. During 2.06 (IQR 1.01-2.94) years of follow-up, 64 (28.7%) patients changed to direct-acting oral anticoagulants. The proportion of switchers was higher in the nurse-led clinic (37.4%) than in the usual care group (20.7%) (P = .006) and these patients spent less time to switch (2.0 [IQR 0.7-2.9] vs 6.0 [IQR 3.7-11.2] years; P < .001). Importantly, the annual rate of ischaemic stroke/TIA was significantly lower in the nurse-led clinic (0.47%/year vs 3.88%/year, P = .016), without differences in safety endpoints.ConclusionA nurse-led AF clinic may offer a "patient-centered" review and holistic follow-up, and it would be associated with a reduction of ischaemic stroke/TIA, without increasing bleeding complications. Further studies should confirm these results.© 2020 John Wiley & Sons Ltd.

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