Two specialised Integrated Care for Atrial Fibrillation (iCARE-AF) clinics led by Flinders Caring Futures Institute’s Professor Jeroen Hendriks are helping South Australians diagnosed with atrial fibrillation (AF), moving towards a reduction of hospitalisations and deaths from this common heart condition.

The clinics at the Royal Adelaide Hospital and Cardiovascular Clinic at Norwood are enabling Professor Hendriks’ trial to track the treatment experiences of 1,400 AF patients over five years, to evaluate the merits of a novel integrated model of care.

This valuable collaboration between Caring Futures Institute, the Centre for Heart Rhythm Disorders at the University of Adelaide and Central Adelaide Local Health Network (CALHN) has seen specialist teams comprising cardiac nurses and cardiologists along with patients and their carers to all bring their expertise to the iCARE-AF Clinics.

“This joint partnership has facilitated a wider collaboration of academic and clinical excellence,” says Professor Hendriks, who holds the inaugural Leo J Mahar Cardiovascular Nursing Chair at Flinders University in a joint-position with CALHN.

“Our research has been co-designed with greater access to the consumer, industry partners and healthcare professionals, making it possible to create an even greater impact.”

 

This approach ensures that patients and their carers are actively involved in their care process, which starts with engaging to best know a patient and their needs, values and preferences, and then aligning this with guideline recommendations to provide tailored care. It involves providing education, support and empowerment in self-management. Patients receive a booklet with detailed information about their AF, treatment and how to report on symptoms, risk factors and lifestyle modifications.

“We also aim to engage them with this process, to keep them actively involved, which is in line with the concept of integrated care,” says Professor Hendriks.

The treatment team is supported in decision making through using a clinical database with incorporated clinical decision-making technology. This serves as a navigation system for the team and patient to guide through the care process, in addition to providing evidence-based treatment and care.

The impact of this research will be significant. Atrial Fibrillation is the most prevalent heart rhythm disorder and is characterised by an irregular and often rapid heart rate that can increase the risk of strokes, heart failure and other heart-related complications.

Consequently, hospitalisation for AF has increased significantly, with current numbers higher than for important cardiac conditions such as heart failure and myocardial infarction. In 2017 and 2018, there were more than 72,000 hospitalisations for AF in Australia and the condition was associated with 9% of deaths in 2018.

Professor Hendriks believes research for the innovative care model could transform future treatment for AF patients and improve the quality of care, resulting in improved quality of life. This could lead to fewer cardiovascular hospitalisations, a reduced mortality rate and vital savings for the healthcare system.

The iCARE-AF Clinic is an example of specialist teams working together to provide comprehensive and integrated care for the community.

Professor Hendriks says the iCARE-AF clinics offer a new integrated care model that could pave the way for future treatment of AF patients.

“The iCARE-AF Clinic is based on the concept of integrated care and uses a patient-centred approach to educate and empower people with AF. It supports them in self-managing their care, which includes lifestyle modification,” says Professor Hendriks.

Other fundamental aspects of this Integrated care model involve multidisciplinary teams, with significant roles for nurses, and comprehensive treatment including the management of AF, prevention of strokes by appropriate treatment of oral anticoagulation, plus the treatment of underlying comorbidity, risk factors and lifestyle modification, along with the use of technology to support the integrated approach.

“A multidisciplinary team including a cardiologist, nurse, the patient, and their carer, provides a comprehensive treatment approach.”

With the ongoing success of the iCARE-AF clinics, Professor Hendriks has a long-term goal of implementing the clinic at multiple sites, with the potential for national implementation, as well as its translation for use in the treatment of other chronic conditions.

“This approach also provides career development opportunities for nurses,” says Professor Hendriks, “as it combines both clinical and academic career paths and has potential to develop clinical research.”