TY - JOUR
T1 - Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation-REAFEL
AU - Bamberg, Carsten
AU - Ladegaard, Caroline Thorup
AU - Aalling, Mathias
AU - Jensen, Dorthea Marie
AU - Madsen, Christoffer Læssøe
AU - Kamil, Sadaf
AU - Gudbergsen, H.
AU - Saxild, Thomas
AU - Schiøtz, Michaela Louise
AU - Grew, Julie
AU - Castillo, Luana Sandoval
AU - Tousgaard, Iben
AU - Johansen, Rie Laurine Rosenthal
AU - Bardram, Jakob Eyvind
AU - Frølich, Anne
AU - Domínguez, Helena
PY - 2023/9/19
Y1 - 2023/9/19
N2 - BACKGROUND: Frail elderly patients are exposed to suffering strokes if they do not receive timely anticoagulation to prevent stroke associated to atrial fibrillation (AF). Evaluation in the cardiological ambulatory can be cumbersome as it often requires repeated visits.AIM: To develop and implement CardioShare, a shared-care model where primary care leads patient management, using a compact Holter monitor device with asynchronous remote support from cardiologists.METHODS: CardioShare was developed in a feasibility phase, tested in a pragmatic cluster randomization trial (primary care clinics as clusters), and its implementation potential was evaluated with an escalation test. Mixed methods were used to evaluate the impact of this complex intervention, comprising quantitative observations, semi-structured interviews, and workshops.RESULTS: Between February 2020 and December 2021, 314 patients (30% frail) were included, of whom 75% had AF diagnosed/not found within 13 days; 80% in both groups avoided referral to cardiologists. Patients felt safe and primary care clinicians satisfied. In an escalation test, 58 primary-care doctors evaluated 93 patients over three months, with remote support from four hospitals in the Capital Region of Denmark.CONCLUSIONS: CardioShare was successfully implemented for AF evaluation in primary care.
AB - BACKGROUND: Frail elderly patients are exposed to suffering strokes if they do not receive timely anticoagulation to prevent stroke associated to atrial fibrillation (AF). Evaluation in the cardiological ambulatory can be cumbersome as it often requires repeated visits.AIM: To develop and implement CardioShare, a shared-care model where primary care leads patient management, using a compact Holter monitor device with asynchronous remote support from cardiologists.METHODS: CardioShare was developed in a feasibility phase, tested in a pragmatic cluster randomization trial (primary care clinics as clusters), and its implementation potential was evaluated with an escalation test. Mixed methods were used to evaluate the impact of this complex intervention, comprising quantitative observations, semi-structured interviews, and workshops.RESULTS: Between February 2020 and December 2021, 314 patients (30% frail) were included, of whom 75% had AF diagnosed/not found within 13 days; 80% in both groups avoided referral to cardiologists. Patients felt safe and primary care clinicians satisfied. In an escalation test, 58 primary-care doctors evaluated 93 patients over three months, with remote support from four hospitals in the Capital Region of Denmark.CONCLUSIONS: CardioShare was successfully implemented for AF evaluation in primary care.
U2 - 10.3390/ijerph20186783
DO - 10.3390/ijerph20186783
M3 - Article
C2 - 37754642
SN - 1661-7827
VL - 20
JO - International Journal of Environmental Research and Public Health
JF - International Journal of Environmental Research and Public Health
IS - 18
ER -