Atrial fibrillation, the prevalent heart rhythm disorder, has been reported to impact over 40 million individuals globally, making it a significant public health concern.
This condition is often associated with multiple other medical conditions, including high blood pressure, coronary artery disease, heart failure, obesity, and chronic kidney disease, with patients presenting an average of five co-existing conditions.
The presence of these comorbidities has been shown to have adverse effects on survival rates. Moreover, research suggests that approximately 75% of atrial fibrillation patients are prescribed at least five medications to manage their condition.
The EHRA-PATHS consortium, funded by the EU and coordinated by the European Society of Cardiology (ESC), is developing a novel software tool aimed at enhancing the management of elderly patients with atrial fibrillation and multiple medical conditions.
The consortium is set to unveil the latest advancements in this clinical innovation at EHRA 2023, a distinguished scientific congress hosted by the ESC.
“EHRA-PATHS is developing a standardised approach to ensure that patients with atrial fibrillation receive evidenced-based therapies for the comorbidities that underlie or complicate their heart rhythm disorder,” added Scientific coordinator Professor Hein Heidbuchel.
EHRA-PATHS is an international project involving multiple centers that aims to provide integrated care for patients with atrial fibrillation and at least one other chronic condition. The project is being coordinated by the European Society of Cardiology (ESC) and the European Heart Rhythm Association (EHRA) and involves a multidisciplinary approach.
In a previous survey conducted by EHRA-PATHS, healthcare professionals reported that the absence of an integrated care model was impeding referrals to specialist services for atrial fibrillation comorbidities.
The findings of patient interviews, which were presented for the first time at EHRA 2023, underscored the importance of integrated treatment and interprofessional collaboration in improving the health of patients with multimorbid atrial fibrillation.
30 patients from Belgium, Greece, Poland, Spain, and the Netherlands with atrial fibrillation and two or more other disorders participated in the in-depth interviews. There were 37% women and a median age of 73. High blood pressure was the most frequent comorbidity, followed by high cholesterol, obesity, hypothyroidism, and diabetes.
Interviewees emphasized the need for improved communication between primary care and hospitals. Several people were dissatisfied with the lack of coordinated treatment and had repeated visits to various sites.
While the respondents were eager to make changes and had some understanding of the connection between comorbidities and atrial fibrillation, they lacked formal training on how to carry out and sustain lifestyle changes.
Researchers from EHRA-PATHS have identified 22 conditions that are important for people with atrial fibrillation. The collaboration has developed clear care pathways for each to determine if certain comorbidity is present or not, to direct further examination of it, and to guarantee successful treatment.
The treatment paths are now being incorporated into a software application that will help medical professionals assess atrial fibrillation patients in a methodical and thorough manner. According to Professor Heidbuchel, this is the cornerstone of the project’s overarching goal, which is to improve the outcomes of patients with atrial fibrillation by methodically identifying and treating underlying illnesses, as well as via interdisciplinary referral or cooperation where necessary.
Clinical research comprising 65 institutions in 14 European nations will examine the software. Part one of the study will analyze the management (evaluation and treatment) of risk factors and comorbidities in around 1,300 individuals aged 65 and older with newly diagnosed atrial fibrillation in order to build a baseline picture.
Phase two will consist of a randomised controlled study including 1,080 patients to see if assigning patients to the software tool improves atrial fibrillation therapy in comparison to standard care.
The twelve comorbid conditions that will be the focus of the trial are hypertension, hyperlipidemia, heart failure, obesity, overweight, renal insufficiency, smoking, diabetes, coronary heart disease, valvular disease, physical activity, chronic obstructive pulmonary disease/asthma, alcohol use.
The primary outcome is the number of risk factors and comorbidities identified and treated during base mapping (part one) and at the conclusion of the randomized controlled trial (part two). Atrial fibrillation symptoms, quality of life, patient and healthcare professional satisfaction, referrals to other specialities, and cost-effectiveness are examples of secondary endpoints.
According to Professor Heidbuchel, the EHRA-PATHS project aims to showcase the benefits of a systematic approach to comorbidities in patients with atrial fibrillation through its clinical trial.
Successful implementation of this tool is expected to not only enhance atrial fibrillation management but also promote uniformity in care delivery across Europe and beyond, benefiting the medical community at large.
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