Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation - REAFEL

Carsten Bamberg
ORCID logo ,
Caroline Thorup Ladegaard
ORCID logo ,
Mathias Aalling
,
Dorthea Marie Jensen
,
Christoffer Læssøe Madsen
,
Sadaf Kamil
ORCID logo ,
Henrik Guldbergsen
ORCID logo ,
Thomas Saxild
,
Michaela Louise Schiøtz
,
Julie Grew
,
Luana Sandoval Castillo
,
Iben Tousgaard
,
Rie Laurine Rosenthal Johansen
,
Jakob Eyvind Bardram
ORCID logo ,
Anne Frølich
,
Helena Domínguez
*
Version 1 : Received: 7 July 2023 / Approved: 10 July 2023 / Online: 11 July 2023 (11:49:45 CEST)

A peer-reviewed article of this Preprint also exists.

Bamberg, C.; Ladegaard, C.T.; Aalling, M.; Jensen, D.M.; Madsen, C.L.; Kamil, S.; Gudbergsen, H.; Saxild, T.; Schiøtz, M.L.; Grew, J.; Castillo, L.S.; Tousgaard, I.; Johansen, R.L.R.; Bardram, J.E.; Frølich, A.; Domínguez, H. Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation—REAFEL. Int. J. Environ. Res. Public Health 2023, 20, 6783. Bamberg, C.; Ladegaard, C.T.; Aalling, M.; Jensen, D.M.; Madsen, C.L.; Kamil, S.; Gudbergsen, H.; Saxild, T.; Schiøtz, M.L.; Grew, J.; Castillo, L.S.; Tousgaard, I.; Johansen, R.L.R.; Bardram, J.E.; Frølich, A.; Domínguez, H. Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation—REAFEL. Int. J. Environ. Res. Public Health 2023, 20, 6783.

Abstract

Background: Frail elderly patients are exposed to suffering the consequences of heart diseases that are not managed timely such as receiving anticoagulation to prevent stroke associated to atrial fibrillation (AF). Referral to the cardiological outpatient department can be cumbersome as it often requires repeated visits. The aim of this project was to use AF as a showcase to develop and implement CardioShare, a shared-care model where primary care leads patient management, using an easy-to-use compact Holter monitor device with asynchronous remote support from cardiologists. Methods: This complex intervention has been developed during a feasibility phase, tested in a pragmatic cluster-randomization trial (primary care clinic as clusters) and its implementation potential evaluated with an escalation test. Mixed methods were used to evaluate the impact of the 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. More than 80% in both groups avoided referral to cardiologists. Patients felt safe and primary care clinicians satisfied. In the escalation test, 58 primary-care doctors used CardioShare to manage 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.

Keywords

sensor; Holter; monitoring; atrial fibrillation; health professionals; frail elderly; cross-sector collaboration; CardioShare model; C3+

Subject

Public Health and Healthcare, Primary Health Care

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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