Improving patient outcomes and reducing health care burden - the need for a new paradigm of care delivery for atrial fibrillation
Year: 2019
Type: dissertation
Abstract: Atrial fibrillation (AF) is an emerging global epidemic. Incidence and prevalence of the condition continues to rise, and AF related health care utilisation has become costly and burdensome. Furthermore, quality of life in AF is akin to those with other chronic cardiovascular conditions such as heart failure. The literature review in Chapter 1 of this thesis explores current research in AF and explores the opportunities that exist for improving outcomes in this condition. Chapter 2 explores national trends in hospitalisations due to AF in Australia and compares this to two other common cardiovascular conditions, heart failure (HF) and myocardial infarction (MI). This demonstrates that hospitalisations due to AF have grown at a significantly greater rate than that of HF and MI and are now the most common cause for cardiovascular hospitalisation in Australia. The rising incidence of AF has led to a search for new risk factors for the condition in addition to exploring appropriate targets and thresholds for existing risk factors. In Chapter 3, the association between alcohol and AF is examined with a view towards determining a lower threshold at which risk of developing the condition is increased. Results of this study demonstrate that up to one standard drink per day does not confer an increase in risk, with gender differences apparent at moderate levels of intake. Chapter 4 is concerned with exploring the current literature in relation to the use of the integrated care approach in AF and its impact on clinically relevant outcomes. This synthesis of the current literature shows that this approach is associated with improvements in several clinically relevant outcomes including reductions in all-cause mortality and cardiovascular hospitalisations. In Chapter 5, the contemporary management of AF is reviewed in a cohort of symptomatic individuals who have presented to the emergency department due to AF with a view towards determining factors predictive of re-presentation. As hospitalisations remain the most expensive component of AF care, this is particularly relevant in the search for modifiable factors that may present an opportunity for intervention. Of interest, the use of a non-standardised personalised AF action plan for management of future episodes was associated with a significant increase in risk of both AF related emergency department presentations and hospitalisations. In Chapter 6, the impact of a brief nurse led educational intervention, which incorporates lifestyle and behavioural goal setting, in AF is evaluated. The brief approach used in this study did not impact on health-related quality of life or cardiovascular risk factor status in a contemporary cohort of individuals with AF at short term follow up. Finally, in Chapter 7, a new target for improving outcomes in this condition is examined, with a review of the current literature concerning polypharmacy and clinically relevant health outcomes in the AF population. This has demonstrated association with several important outcomes including increased all-cause mortality, major bleeding and clinically relevant non-major bleeding.
Author: Celine Gallagher
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3002599601