New study offers better care for people with life-threatening irregular heartbeat

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A new Australian study has found that personalised home-based education sessions for patients living with Atrial Fibrillation (AF) can dramatically cut their hospital admissions by up to 26 percent.

More than half a million Australians are currently living with AF, which is a major cause of stroke and can also lead to heart failure. It is the underlying cause of about 2,100 deaths a year and has claimed more than 15,960 lives over the last 10 years.

Between 10 to 30 percent of AF patients are admitted to hospital each year, according to the National Heart Foundation, which co-funded the research.

It is more common to be hospitalised in Australia for AF than it is for heart failure or heart attack.

For great grandmother Jacqui Stapleton, the trial program was what she needed to help her manage her condition daily.

The 75-year-old, who lives in Elizabeth in South Australia, was diagnosed with AF in 2012. She has been to hospital just once since she joined the study, which she puts down to the self-management techniques she has learned. She sees her cardiologist every six months for a check-up.

The findings of the HELP–AF (Home-based Education and Learning Program for Atrial Fibrillation) study were presented at the European Society of Cardiology (ESC) Congress in Paris on Sunday 1 September by the study’s principal investigator, Professor Prashanthan Sanders. He is the Director, Centre for Heart Rhythm Disorders at the University of Adelaide.

Professor Sanders and a multidisciplinary team trialed a new approach to help patients manage their condition using home-based educational sessions that were designed to empower them to self-monitor and manage their AF. A pharmacist or nurse visited patients at their home for 60-90 minutes. This was followed up with another session six to eight weeks later to reinforce the messages.

The two-year trial found that the structured information sessions, when combined with an action plan from their doctor to manage episodes of AF and over-the-phone support, resulted in a:

-           26 percent reduction in total unplanned hospitalisations

-           31 per cent reduction in unplanned AF hospitalisations, and

-           49 percent reduction in the group’s total unplanned cardiac-related hospitalisations

Professor Sanders said the program offered major benefits and should be made available to all AF patients in Australia.

“The results clearly show that short-term intervention - two structured education sessions - can decrease hospitalisation and improve AF-related quality of life. It could deliver major savings for the hospital system,” Professor Sanders said.

The trial involved 627 patients who had presented to six emergency departments in South Australia because of AF.

During the home visits, the pharmacist and nurse focus on four topics: medications, stroke prevention, maintaining a healthy lifestyle and what to do if they were having an AF episode, which can include racing heart and pulse, sweating, dizziness and shortness of breath.

The sessions were personalised to suit their education level, cultural background and age. The research team devised a simple guide for what to do during an AF event called REST – Relax, Estimate pulse, See your action plan, Telephone help line – which patients could display on their fridge and carry around as a wallet card.

Professor Sanders said the patients were encouraged to have a family member with them during the education session and they felt relaxed in their own home.

The National Heart Foundation’s General Manager of Heart Health, Bill Stavreski, said the results were encouraging and the program could provide major benefits for patients and the health system.

“Studies have shown that AF hospitalisations in Australia are increasing at a greater rate than for other cardiovascular conditions.

"The burden for people living with AF, and on the health care system, will keep escalating unless AF, its risk factors and complications are prevented and treated effectively. 

Professor Sanders’ research will contribute to our understanding of how to manage AF,” Mr Stavreski said.

The study was funded through a joint Heart Foundation and South Australian Government cardiovascular fund. The fund was established after the Heart Foundation received a $5 million bequest from the estate of Beth Stewart Klugh.

Quotes attributable to trial participant Mrs Jacqui Stapleton:

“Now I recognise when it’s happening, and I know what to do. I was taught how to take my pulse, I was taught breathing techniques, how to relax, wait, and then go hospital if I have to.”

“To control and monitor my situation I bought a watch that monitors heart rate. I keep the REST card in my purse.”

“I feel safe now.”