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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: Pragmatic, multicentre, randomised controlled trial
The Lancet, Volume 385, No. 9970, Year 2015
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Description
Background Patients are increasingly being admitted with chronic atrial fibrillation, and disease-specific management might reduce recurrent admissions and prolong survival. However, evidence is scant to support the application of this therapeutic approach. We aimed to assess SAFETY - a management strategy that is specific to atrial fibrillation. Methods We did a pragmatic, multicentre, randomised controlled trial in patients admitted with chronic, non-valvular atrial fibrillation (but not heart failure). Patients were recruited from three tertiary referral hospitals in Australia. 335 participants were randomly assigned by computer-generated schedule (stratified for rhythm or rate control) to either standard management (n=167) or the SAFETY intervention (n=168). Standard management consisted of routine primary care and hospital outpatient follow-up. The SAFETY intervention comprised a home visit and Holter monitoring 7-14 days after discharge by a cardiac nurse with prolonged follow-up and multidisciplinary support as needed. Clinical reviews were undertaken at 12 and 24 months (minimum follow-up). Coprimary outcomes were death or unplanned readmission (both all-cause), measured as event-free survival and the proportion of actual versus maximum days alive and out of hospital. Analyses were done on an intention-to-treat basis. The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTRN 12610000221055). Findings During median follow-up of 905 days (IQR 773-1050), 49 people died and 987 unplanned admissions were recorded (totalling 5530 days in hospital). 127 (76%) patients assigned to the SAFETY intervention died or had an unplanned readmission (median event-free survival 183 days [IQR 116-409]) and 137 (82%) people allocated standard management achieved a coprimary outcome (199 days [116-249]; hazard ratio 0·97, 95% CI 0·76-1·23; p=0·851). Patients assigned to the SAFETY intervention had 99·5% maximum event-free days (95% CI 99·3-99·7), equating to a median of 900 (IQR 767-1025) of 937 maximum days alive and out of hospital. By comparison, those allocated to standard management had 99·2% (95% CI 98·8-99·4) maximum event-free days, equating to a median of 860 (IQR 752-1047) of 937 maximum days alive and out of hospital (effect size 0·22, 95% CI 0·21-0·23; p=0·039). Interpretation A post-discharge management programme specific to atrial fibrillation was associated with proportionately more days alive and out of hospital (but not prolonged event-free survival) relative to standard management. Disease-specific management is a possible strategy to improve poor health outcomes in patients admitted with chronic atrial fibrillation. Funding National Health and Medical Research Council of Australia. © 2015 Elsevier Ltd.
Authors & Co-Authors
Stewart, Simon D.
Australia, Sydney
Australian Catholic University
Australia, Melbourne
Baker Heart and Diabetes Institute
Ball, Jocasta C.
Australia, Sydney
Australian Catholic University
Horowitz, John D.
Australia, Woodville South
The Queen Elizabeth Hospital, North Western Adelaide Health Service
Marwick, Thomas H.
Australia, Hobart
Menzies Institute for Medical Research
Chan, Yih Kai
Australia, Sydney
Australian Catholic University
Australia, Melbourne
Baker Heart and Diabetes Institute
Esterman, Adrian J.
Australia, Adelaide
University of South Australia
Thompson, David R.
Australia, Sydney
Australian Catholic University
Scuffham, P. Anthony
Australia, Brisbane
Griffith Health
Carrington, Melinda J.
Australia, Sydney
Australian Catholic University
Australia, Melbourne
Baker Heart and Diabetes Institute
Statistics
Citations: 101
Authors: 9
Affiliations: 8
Identifiers
Doi:
10.1016/S0140-6736(14)61992-9
ISSN:
01406736
Research Areas
Environmental
Health System And Policy
Noncommunicable Diseases
Study Design
Randomised Control Trial
Cohort Study