Atrial Fibrillation
Atrial Fibrillation
AFFIRMO – “Atrial fibrillation integrated approach in frail, multimorbid and polymedicated older people”
The general aging of the population has led to an increasing number of people having multiple chronic diseases simultaneously. This places new demands on the organization of our healthcare system and the clinical approach of individuals, in order to manage these challenges effectively.
Atrial fibrillation (or heart fibrillation) is a heart rhythm disorder where electrical signals are generated in an uncoordinated manner, causing the atria to contract rapidly. Besides the varying symptom burden among patients, atrial fibrillation is a serious clinical condition that can lead to complications such as stroke and heart failure. Multimorbidity in atrial fibrillation patients has been shown to result in significantly poorer outcomes, requiring individualized prioritization of different diseases and treatments to improve both quality of life and survival.
A holistic or integrated treatment approach known as Atrial fibrillation Better Care (ABC) has been developed. This approach is based on three key principles: (i) preventing stroke through anticoagulation therapy, (ii) improving symptoms by considering patient preferences and making decisions about treatment methods that either control heart rate or rhythm, and (iii) managing cardiovascular and non-cardiovascular risk factors, comorbidities, and promoting healthier lifestyles.
In this context, the EU has supported AFFIRMO through Horizon 2020 (grant agreement no. 899871) to conduct a systematic analysis of the role of multimorbidity in atrial fibrillation patients, and to investigate the effect of a patient-centered, stratified treatment approach for elderly atrial fibrillation patients with multimorbidity, using the "ABC care pathway" aimed at facilitating interdisciplinary shared decision-making to improve outcomes for this growing patient group.
A central component of AFFIRMO is a comprehensive geriatric assessment within the ABC care pathway, providing in-depth insights into the health status of elderly multimorbid patients and characterizing each patient based on their frailty level. Such insights have been closely associated with significant improvements in health status and prognosis for these patients.
AFFIRMO commenced in April 2021 and the project's work is structured into nine work packages (WPs) over a total duration of 5 years. The project aims to provide enhanced tools for risk stratification of multimorbid atrial fibrillation patients. This is part of the objectives of WP2 and WP3, which will characterize patients more precisely and thereby provide necessary information for designing a structured follow-up process. At the core of the project is a multinational cluster-randomized clinical trial, where a web- and mobile app-based version of the ABC care pathway (iABC) will be tested against standard treatment, and its effect evaluated on clinical outcomes (WP5, WP6, and WP7). WP4 will evaluate a detailed assessment of patients' needs and quality indicators. Based on results from the randomized control group, WP8 will conduct a health economic analysis. Patient empowerment is also a central feature of the program, to be explored in WP9.
The activities of the AFFIRMO consortium are coordinated and organized (WP1) under the scientific coordination of Prof. Søren Paaske Johnsen (Aalborg University) and Prof. Gregory Lip (University of Liverpool and Aalborg University).
Disease Burden of Atrial Fibrillation
The following research program is supported by the Danish Cardiovascular Academy.
Atrial fibrillation most frequently occurs in the older segment of the population. Both the incidence and prevalence are increasing, and today, the disease is the most common heart rhythm disorder in clinical practice and is considered an epidemic. Studies of individuals from the Western world suggest that one in three will develop the disease during their lifetime. Atrial fibrillation is a severe diagnosis that is associated with complications such as stroke and heart failure. Patients lose an average of two years of expected lifetime compared to individuals without the disease. Atrial fibrillation poses a significant challenge to public health and the healthcare system due to its frequent occurrence, its severe prognosis, and limited resources. Due to the growth of the elderly population, the atrial fibrillation epidemic will likely threaten the scarce resources of the healthcare system to a much greater extent in the future because of the growth in number of patients and multimorbidity.
In this research program, we link data from nationwide registries and examine the disease burden of atrial fibrillation. We use new epidemiological and biostatistical methods that provide significant knowledge and new perspectives on patient characteristics, incidence, patient course, treatment, prognosis, and health economics. The results are essential for promoting preventive efforts in the general population and for improving the prognosis, quality of treatment, and patient safety for patients with atrial fibrillation. The results are necessary as decision support in the planning and prioritization of health services within the cardiovascular area.
The research program is conducted in collaboration with Associate Professor Ludovic Trinquart (Tufts Medical Center, Boston), Professor Emelia J. Benjamin (Boston University, Boston), and Professor Gregory Lip (University of Liverpool).