Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation—REAFEL

Carsten Bamberg, Caroline Thorup Ladegaard, Mathias Aalling, Dorthea Marie Jensen, Christoffer Læssøe Madsen, Sadaf Kamil, Henrik Gudbergsen, Thomas Saxild, Michaela Louise Schiøtz, Julie Grew, Luana Sandoval Castillo, Iben Tousgaard, Rie Laurine Rosenthal Johansen, Jakob Eyvind Bardram, Anne Frølich and Helena Domínguez ()
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Carsten Bamberg: Cardiology Department Y Bispebjerg and Frederiksberg Hospital, Capital Region, 2000 Frederiksberg, Denmark
Caroline Thorup Ladegaard: Cardiology Department Y Bispebjerg and Frederiksberg Hospital, Capital Region, 2000 Frederiksberg, Denmark
Mathias Aalling: VihTek Research Center for Welfare Technology Capital Region, 2600 Copenhagen, Denmark
Dorthea Marie Jensen: Cardiology Department Y Bispebjerg and Frederiksberg Hospital, Capital Region, 2000 Frederiksberg, Denmark
Christoffer Læssøe Madsen: Cardiology Department Y Bispebjerg and Frederiksberg Hospital, Capital Region, 2000 Frederiksberg, Denmark
Sadaf Kamil: Cardiology Department Y Bispebjerg and Frederiksberg Hospital, Capital Region, 2000 Frederiksberg, Denmark
Henrik Gudbergsen: Section of General Practice, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark
Thomas Saxild: Grøndalslægerne Godthåbsvej 239a, Vanløse, 2720 Copenhagen, Denmark
Michaela Louise Schiøtz: Center for Clinical Research and Prevention Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
Julie Grew: Center for Clinical Research and Prevention Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
Luana Sandoval Castillo: Geriatrics Department, Bispebjerg Hospital, 2400 Copenhagen, Denmark
Iben Tousgaard: Department of Quality and Education, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
Rie Laurine Rosenthal Johansen: Department of Quality and Education, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
Jakob Eyvind Bardram: Department of Health Technology, Digital Health, Personalized Health Technology, Technical University of Denmark, 2800 Copenhagen, Denmark
Anne Frølich: Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, 4180 Sorø, Denmark
Helena Domínguez: Cardiology Department Y Bispebjerg and Frederiksberg Hospital, Capital Region, 2000 Frederiksberg, Denmark

IJERPH, 2023, vol. 20, issue 18, 1-14

Abstract: BACKGROUND: Frail elderly patients are exposed to suffering strokes if they do not receive timely anticoagulation to prevent stroke associated to atrial fibrillation (AF). Evaluation in the cardiological ambulatory can be cumbersome as it often requires repeated visits. AIM: To develop and implement CardioShare, a shared-care model where primary care leads patient management, using a compact Holter monitor device with asynchronous remote support from cardiologists. METHODS: CardioShare was developed in a feasibility phase, tested in a pragmatic cluster randomization trial (primary care clinics as clusters), and its implementation potential was evaluated with an escalation test. Mixed methods were used to evaluate the impact of this complex intervention, comprising quantitative observations, semi-structured interviews, and workshops. RESULTS: Between February 2020 and December 2021, 314 patients (30% frail) were included, of whom 75% had AF diagnosed/not found within 13 days; 80% in both groups avoided referral to cardiologists. Patients felt safe and primary care clinicians satisfied. In an escalation test, 58 primary-care doctors evaluated 93 patients over three months, with remote support from four hospitals in the Capital Region of Denmark. CONCLUSIONS: CardioShare was successfully implemented for AF evaluation in primary care.

Keywords: sensor; Holter; monitoring; atrial fibrillation; health professionals; frail elderly; cross-sector collaboration; CardioShare model; C3+ (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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