A Nurse-Led Integrated Chronic Care E-Enhanced Atrial Fibrillation (NICE-AF) Clinic in the Community: A Preliminary Evaluation.
Brigitte Fong Yeong WooWilson Wai Sun Wai Sun TamTaiju RangpaWei Fong LiauJennifer NathaniaToon Wei LimPublished in: International journal of environmental research and public health (2022)
The current physician-centric model of care is not sustainable for the rising tide of atrial fibrillation. The integrated model of care has been recommended for managing atrial fibrillation. This study aims to provide a preliminary evaluation of the effectiveness of a Nurse-led Integrated Chronic care E-enhanced Atrial Fibrillation (NICE-AF) clinic in the community. The NICE-AF clinic was led by an advanced practice nurse (APN) who collaborated with a family physician. The clinic embodied integrated care and shifted from hospital-based, physician-centric care. Regular patient education, supplemented by a specially curated webpage, fast-tracked appointments for hospital-based specialised investigations, and teleconsultation with a hospital-based cardiologist were the highlights of the clinic. Forty-three participants were included in the six-month preliminary evaluation. No significant differences were observed in cardiovascular hospitalisations ( p -value = 0.102) and stroke incidence ( p -value = 1.00) after attending the NICE-AF clinic. However, significant improvements were noted for AF-specific QoL ( p = 0.001), AF knowledge ( p < 0.001), medication adherence ( p = 0.008), patient satisfaction ( p = 0.020), and depression ( p = 0004). The preliminary evaluation of the NICE-AF clinic demonstrated the clinical utility of this new model of integrated care in providing safe and effective community-based AF care. Although a full evaluation is pending, the preliminary results highlighted its promising potential to be expanded into a permanent, larger-scale service.
Keyphrases
- atrial fibrillation
- healthcare
- primary care
- quality improvement
- palliative care
- left atrial
- catheter ablation
- oral anticoagulants
- left atrial appendage
- heart failure
- direct oral anticoagulants
- mental health
- randomized controlled trial
- pain management
- emergency department
- systematic review
- affordable care act
- patient satisfaction
- climate change
- venous thromboembolism
- depressive symptoms
- case report
- physical activity
- acute coronary syndrome
- risk assessment
- blood brain barrier
- brain injury
- cerebral ischemia