Plain language summary Are services organised to deliver care for people with atrial fibrillation (irregular heartbeat) better than usual (routine) care? Key messages • Organised care services for atrial fibrillation (AF) probably cause a large reduction in death from all causes and do reduce heart‐related hospital admissions, but they probably make little to no difference to hospital admissions from all causes and may not reduce heart‐related death compared with routine care (care provided as part of normal practice). • Organised care services for AF may not reduce complications such as stroke and mini‐stroke and major complications related to bleeding in the brain compared to routine care. • Larger, well‐designed studies are needed to give better estimates of the benefits and potential harms of organised care services for AF. What is atrial fibrillation? Atrial fibrillation (AF) is an irregular heartbeat that happens when the electrical signals in the heart fire quickly at the same time. This causes the heart to beat too fast or too slow, which can cause troubling symptoms and serious medical complications, including blood clots that can lead to stroke (where blood flow to the brain is blocked). How is atrial fibrillation treated? Atrial fibrillation is treated with lifestyle changes, medication, and procedures, including surgery, to help prevent blood clots, control the heartbeat, or restore the heart’s normal rhythm. What did we want to find out? Organised care services for AF involve: (i) providing care that is focused on improving people’s care experiences, health outcomes, and quality of life; (ii) that is delivered by a team of healthcare providers from various fields of study working together; and (iii) that uses technology to support the integrated approach. Routine care is care provided as part of normal practice. We wanted to find out if organised care services for AF were better than usual (routine) care in reducing death and hospital admission from all causes. We also wanted to find out if organised care services for AF were better than routine care in reducing heart‐related death and hospital admissions, AF‐related emergency department visits, complications such as stroke and mini‐stroke, major and minor complications related to bleeding in the brain, AF‐related quality of life, AF symptoms, length of hospital stay, and cost related to the services. What did we do? We searched for studies comparing organised care services for AF to routine care in adults diagnosed with AF. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes. What did we find? We found 8 studies involving a total of 8205 people with AF, with an average age of 60 to 73 years. The included studies were performed in China, the Netherlands, and Australia. All eight studies reported receiving individual grants or a combination of public funding and funding from industry. Compared to routine care, organised AF care services: ‐ prevent one death from all causes for every 37 patients treated and followed for six years; ‐ prevent one hospital admission from all causes for every 101 patients treated and followed for two years; ‐ prevent one heart‐related death for every 86 patients treated and followed for six years; and ‐ prevent one heart‐related hospital admission for every 28 patients treated and followed for six years; but ‐ may make little to no difference to complications such as stroke and mini‐stroke (one complication prevented for every 588 patients treated and followed for six years) and major complications related to bleeding in the brain (one bleeding complication prevented for every 556 patients treated and followed for six years). No study assessed minor complications related to bleeding in the brain. What are the limitations of the evidence? Our confidence in the evidence for death and hospital admissions from all causes is only moderate because it is possible that some study participants were aware of which treatment they were getting, which could have influenced the results. We have little confidence in the evidence for heart‐related death because the ways treatment was delivered varied across studies, and it is possible that some study participants were aware of which treatment they were getting, which could have influenced the results. We are confident that organised care services for AF reduce heart‐related hospital admissions. We have little confidence in the evidence for complications and bleeding‐related complications specifically because the ways treatment was delivered varied across studies, and it is possible that some study participants were aware of which treatment they were getting, which could have influenced the results. Additionally, the small number of studies prevents us from being certain about the results. How up‐to‐date is the evidence? The evidence is current to October 2022.
【저자키워드】 Adult, Hospitalization, stroke, Telemedicine, bias, Atrial fibrillation, humans, Quality of life, cause of death, Aged, randomized controlled trials as topic, Atrial Fibrillation/mortality, Atrial Fibrillation/therapy, Stroke/mortality,