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, Henrik

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

N1 - Publisher Copyright: © 2023 by the authors.

PY - 2023

Y1 - 2023

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.

KW - atrial fibrillation

KW - C3+

KW - CardioShare model

KW - cross-sector collaboration

KW - frail elderly

KW - health professionals

KW - Holter

KW - monitoring

KW - sensor

U2 - 10.3390/ijerph20186783

DO - 10.3390/ijerph20186783

M3 - Journal article

C2 - 37754642

AN - SCOPUS:85172764530

VL - 20

JO - International Journal of Environmental Research and Public Health

JF - International Journal of Environmental Research and Public Health

SN - 1661-7827

IS - 18

M1 - 6783

ER -