Reaching the Frail Elderly for the Management of Atrial Fibrillation

Hypothesis Our overall hypothesis is, that using the cardio-relay model it is possible to provide adequate treatment to frail patients that have difficulties to attend repeated visits at the hospital-based cardiologist office.

Our concrete hypothesis is that a larger number of frail patients reaches adequate treatment with the cardio-relay model compared with conventional treatment and the patient remains confident with the distant support by the cardiologist.

METHODS This is a pragmatic clinical trial that uses mixed methods in different stages of the project to test this hypothesis. Observational during the initial feasibility period, an open-label cluster-randomization trial and an iterative implementation period.

Phase 1 - Feasibility During this phase, a single GP clinic is used to establish the elements that permit to establish the cardio-relay model. Hence, a field study is required to initiate the study.

Subsequently, the first of such elements in the cardio-relay model is a text exchange initiated by the GP addressing a request to the cardiologist to assess the need for heart rhythm monitoring. This is a replacement of usual referral when the cardiologist is expected to plan an appointment for the patient In the cardiology outpatient clinic or reject the referral. In the cardio-relay model, through a text exchange. The GP may require further examinations and add eventual results available in the hospital electronic records from previous contacts. The GP, the cardiologist and the patient (welcoming help from relatives and carers) can then agree on need for heart rhythm monitoring. The GP has available compact Holter sensors, C3+, from Cortrium ApS and can immediately initiate recordings at their office or at the patient's home. The duration of the recording is 24 hours as standard, but can agreed to prolong or repeat between the GP, the cardiologist and the patient. C3+ has memory for continuous electrocardiogram recording and built-in accelerometer, for up to three weeks and battery capacity for one weeks. The finalized recordings can be uploaded to the cloud by the GP and the cardiologist provides the GP with a result of the recording and a proposal for treatment according to the findings or further evaluation, which continuous the dialogue across the sectors