IntegRAted Chronic Care Program at Specialized AF Clinic Versus Usual CarE in Patients With Atrial Fibrillation - RACE4

Not Applicable

Completed

• Conditions: Atrial Fibrillation
• Interventions: Other: Specialized outpatient AF Clinic; Other: Usual Care

• Registration Number: NCT01740037
• Lead Sponsor: Maastricht University Medical Center

Brief Summary

Rationale: The treatment of patients with atrial fibrillation is often inadequate due to poor guideline adherence. An integrated chronic care program (ICCP) at a specialized AF-clinic was found to be superior to usual care provided by a cardiologist in terms of cardiovascular hospitalizations and cardiovascular mortality.

Hypothesis: treatment at a specialized AF clinic is superior to usual care in terms of cardiovascular mortality and cardiovascular hospitalizations, cost-effectiveness, quality of life and guideline adherence.

Objectives: primary objective is to show that an ICCP reduces cardiovascular hospitalizations and mortality.

Study design: randomized controlled trial with two study arms: usual care provided by cardiologists (control) versus integrated chronic care program at a specialized AF clinic (intervention) in 8 hospitals in the Netherlands. The RACE4 is an event driven study. A total number of 246 events is needed. In total 1716 patients with newly diagnosed AF will be included. Total duration of the study is 5 years and 10 months with a minimal follow up of 1 year. Data is collected at inclusion, after 3, 6, 12 months, every year thereafter and at the end of the study.

Study population: Patients older than 18 year with newly diagnosed AF.

Intervention: The intervention is delivered through the specialized outpatient AF clinic. The multidisciplinary team at the AF clinic consists of a nurse practitioner or physician assistant or specialised cardiovascular nurse, cardiologist, and is guided by guidelines-based decision support software program based on the applicable ESC guideline recommendations. The use of a web-based patient centered management of patient's own medication (Medication manager TM) was optional. A standardized diagnostic, treatment and follow-up pathway was performed within the ICCP.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2012-10-16
• Study First Submitted QC: 2012-11-29
• Study Start: 2012-12
• Study First Posted: 2012-12-04
• Primary Completion: 2018-09-30
• Study Completion: 2018-09-30
• Status Verified: 2019-04
• Last Update Submitted: 2019-05-22
• Last Update Posted: 2019-05-28

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 1375

Inclusion Criteria

1. Patients with newly diagnosed AF detected on electrocardiogram (ECG), holter recordings or event recorder with a duration > 30 seconds, 3 months before inclusion or
2. Patients with a history of diagnosed AF, with no regular control at a cardiologist for AF in the last 2 years and referred by a (non-)cardiologic medical specialist for new diagnostics or therapeutic issue;
3. Age ≥18 years.

Exclusion Criteria

1. No electrocardiographic objectified AF;
2. Unstable heart failure defined as NYHA IV or heart failure necessitating hospital admission < 3 months before inclusion;
3. Acute coronary syndrome (acute myocardial infarction or instable angina pectoris, with two of the following characteristics: chest pain and/ or ischemic electrocardiographic changes, and/ or cardiac enzyme rise) < 3 months before inclusion;
4. Untreated hyperthyroidism or < 3 months euthyroidism before inclusion;
5. Foreseen pacemaker, internal cardioverter defibrillator, and/ or cardiac resynchronization therapy;
6. Cardiac surgery ≤ 3 months before inclusion;
7. Planned cardiac surgery;
8. Regular control and treatment, also for AF, at another specialized outpatient cardiac clinic;
9. Patient is not able to fill in the questionnaires;
10. Participation in other clinical study.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Specialized AF-clinic	Specialized outpatient AF Clinic	Management of AF patients in specialized outpatient AF Clinics according to the principles of an integrated chronic care program (ICCP) performed by a nurse practitioner/ physician assistant/ specialised cardiovascular nurse, cardiologist, supported by an ICT decision support tool based on professional guidelines (CardioConsult AF®). The use of a web-based patient centered management of patient's own medication (Medication manager TM) was optional. A standardized diagnostic, treatment and follow-up pathway was performed within the ICCP. In addition, the intervention is based on identifying risk factors and potential problems in patients, and addressing needs through dynamic use of personalized education and adjustment of treatment.
Usual Care	Usual Care	Usual care provided by cardiologists at the regular outpatient clinic.

Primary Outcome Measures

Name	Time	Method
The primary endpoint is a composite of unplanned admission to the hospital for any cardiovascular reason and cardiovascular death.	Follow up with minimum of 1 year and a maximum of 5 years and 10 months

Secondary Outcome Measures

Name	Time	Method
All components of the primary endpoint	Follow up with minimum of 1 year and a maximum of 5 years and 10 months
Total number of unplanned hospitalizations related to atrial fibrillation	Follow up with minimum of 1 year and a maximum of 5 years and 10 months
Recurrent unplanned cardiovascular hospitalizations	Follow up with minimum of 1 year and a maximum of 5 years and 10 months
Costs and cost-effectiveness	baseline, 1 year, 2 years, 3 years	Costs, Quality Adjusted Life Years (QALYs) and Cost-effectiveness (Incremental Cost-Effectiveness Ratio - ICER)
Patient Quality of life	Baseline, 1 year, 2 years, 3 years	Patient's perception of severity of arrhythmia-related symptoms is measured by using the AFSS
Knowledge of AF	Baseline, 1 year, 2 years, 3 years	Netherlands Knowledge Scale on AF
Compliance to medication	Baseline, 1 year, 2 years, 3 years	To measure the level of activation of a specific individual the PAM-13 Dutch is used
All-cause mortality	Minimum of 1 year and a maximum of 5 years and 10 months
Duration of unplanned cardiovascular hospitalizations	Follow up with minimum of 1 year and a maximum of 5 years and 10 months
Duration of unplanned hospitalizations related to atrial fibrillation	Follow up with minimum of 1 year and a maximum of 5 years and 10 months
Implementation of care	Follow up with minimum of 1 year and a maximum of 5 years and 10 months	The extent to which the comprehensive cardiovascular treatment is in accordance with the most recent ESC guidelines Management of Atrial Fibrillation, the HF guidelines of acute and chronic heart failure and the CVD prevention guidelines
Total number of unplanned all-cause hospitalizations	Follow up with minimum of 1 year and a maximum of 5 years and 10 months
Duration of unplanned all-cause hospitalizations	Follow up with minimum of 1 year and a maximum of 5 years and 10 months
Anxiety and/ or depression	Baseline, 1 year, 2 years, 3 years	HADS-NL
Total number of unplanned cardiovascular hospitalizations	Follow up with minimum of 1 year and a maximum of 5 years and 10 months

Trial Locations

Locations (8)

Medisch Centrum Leeuwarden; 🇳🇱 Leeuwarden, Netherlands

UMCG; 🇳🇱 Groningen, Netherlands

Martini Ziekenhuis; 🇳🇱 Groningen, Netherlands

Spaarne Gasthuis; 🇳🇱 Haarlem, Netherlands

MUMC+; 🇳🇱 Maastricht, Netherlands

Canisius Wilhelmina Ziekenhuis Nijmegen; 🇳🇱 Nijmegen, Netherlands

Zaans Medisch Centrum; 🇳🇱 Zaandam, Netherlands

Isala; 🇳🇱 Zwolle, Netherlands