Home-based education reduces hospitalizations of atrial fibrillation patients

Home-based and personalised education keeps people suffering with atrial fibrillation out of hospital, found a new study.

The findings were presented at ESC Congress 2019.

Over the last few decades, the number of people affected with atrial fibrillation around the world has grown exponentially because populations are getting older and acquiring lifestyle-related conditions such as high blood pressure, obesity, sleep apnoea and diabetes that raise the risk of developing atrial fibrillation.

"Some hospital admissions for atrial fibrillation are likely preventable through better education of those living with the condition. We believed that involving patients in their care, helping them understand their condition, and providing tools to manage it might avoid hospitalisations," said principal investigator Professor Prash Sanders of the University of Adelaide, Australia.

The study enrolled 627 patients with atrial fibrillation presenting to the emergency department of six hospitals in Adelaide, South Australia.

Patients were approached to participate within two months of their emergency department presentation.

Those allocated to the intervention received two educational home visits by a nurse or pharmacist: one approximately two weeks after enrolment and the second six weeks after that. They received a booklet for future reference.

Education was delivered in a structured way and focused around four messages: 1) management of future atrial fibrillation episodes; 2) importance of medicines to manage symptoms and stroke risk; 3) appropriate use of stroke prevention medicines; and 4) role of lifestyle modification. Messages were personalised to target areas where behaviour change was needed.

Patients were followed up for two years for the primary endpoints of all-cause unplanned hospitalisation and health-related quality of life evaluated by the 36-Item Short Form Health Survey.

At 24 months, total unplanned hospitalisations were 233 in the HELP-AF group and 323 with usual care with an incident rate ratio of 0.74 (95 per cent confidence interval 0.62-0.89; p=0.001).

After multivariable adjustment, the intervention reduced total unplanned hospitalisations by 26 per cent, atrial fibrillation related hospitalisations by 31 per cent, and other cardiovascular hospitalisations by 49 per cent, while having no impact on non-cardiac hospitalisations.

Prof Sanders stated, "The study shows that education delivered in a structured and individualised way within the patient's home has a dramatic impact not only on hospitalisations for atrial fibrillation but on all cardiovascular hospitalisations.