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Specialized AF-Clinics for patients with Atrial Fibrillation: iCARE-AF Clinics

Professor Jeroen Hendriks, Institution: Flinders University

2018 Future Leader Fellowship

Years funded: 2019-2022


Atrial fibrillation (AF) is a prevalent cardiac arrhythmia with an estimated 33.5 million patients globally in 2010, and evidence suggests that these figures continue rising, whereby 25% of adults >40 years will be diagnosed with AF in their life. AF poses a substantial burden to the health care system; it is the most common cardiovascular cause of hospitalisation in Australia (~61,000), with an annual cost of $5,200 per person. AF management, including cardiovascular (CV) risk factors, has been sub-optimal and not according to evidence-based guidelines.

Integrated care management is recommended in Guidelines as the optimal approach to manage AF and consequently redesign daily practice. Recent data demonstrates the importance of comprehensive specialised AF clinics and intensive management of cardiovascular risk factors with beneficial effects on AF symptom burden, hospitalization and mortality, and costs.

In the proposed trial, structured AF management including intensive risk factor management will be combined in to a specialised, multidisciplinary iCARE-AF Clinic. This clinic fuses significant care components as well as specialists and patients to ensure necessary collaboration and actively involves patients in the care process, following a patient-centred approach.

 It is hypothesised that this iCARE AF Clinic will reduce all-cause hospitalization and mortality in patients with AF (primary endpoint).

To test this hypothesis, the iCARE clinic will be compared with standard care in a prospective, multi-centre, randomised controlled trial, involving 4 teaching centres in Australia and 2 in New-Zealand. Follow-up will be 24 months. Expected outcome: reduction of AF symptoms and improved quality of life; improved AF management including related cardiovascular diseases; reduction in mortality, hospitalisation, and health care costs; policy change. This study represents an important step in Transforming Healthcare by translating evidence in the Australian context.

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