- Copyright © 2022 Marshfield Clinic Health System
Multidisciplinary Integrated Care in Atrial Fibrillation (MICAF): A Systematic Review and Meta-Analysis
- Adnan Khan, MD, MSc, PhD*⇑,
- Alberto Cereda, MD, MSc†,
- Claudia Walther, MD, MSc‡ and
- Aqsa Aslam, MBBS, MPhil, PhD Scholar§
- *Sharif Medical City, Lahore, Pakistan, and London School of Economics and Political Science, London, UK
- †HPG XXII Hospital, Bergamo Italy
- ‡University Hospital of Theodor-Stern-Kai 7, Frankfurt Germany
- §Assistant Professor of Pathology, Islamabad Medical & Dental College, Islamabad
- Corresponding Author:
Adnan Khan, MD, MSc, PhD, Sharif Medical City, Lahore, Pakistan, and London School of Economics and Political Science, London, UK; Email: adnan.khan{at}outlook.com
Abstract
Objective: To assess the effectiveness of multidisciplinary integrated care in the clinical outcomes of atrial fibrillation patients.
Methods: Medline, EMBASE, and the CENTRAL trials registry of the Cochrane Collaboration were searched for articles on multidisciplinary integrated care in atrial fibrillation patients. The systematic review and meta-analysis included six and five articles, respectively, that compared the outcomes between the integrated care group and control group.
Results: Multidisciplinary integrated care was concomitant with a decrease in all-cause mortality (OR 0.52, 95%CI 0.36-0.74, P=0.0003) and cardiovascular hospitalization (OR 0.66, 95%CI 0.49-0.89, P=0.007). Multidisciplinary integrated care had no significant impact on major adverse cardiovascular event (MACE) (OR 0.76, 95%CI 0.37-1.53, P=0.44), cardiovascular deaths (OR 0.49, 95% CI 0.21-1.17, P=0.11), atrial fibrillation (AF)-related hospitalization (OR 0.76, 95%CI 0.53-1.09, P=0.14), major bleeding (OR 1.02, 95%CI 0.59-1.75, P=0.94), minor bleeding (OR 1.12, 95%CI 0.55-2.26, P=0.76), and cerebrovascular events (OR 0.72, 95%CI 0.45-1.18, P=0.19).
Conclusion: In comparison to usual care, a multidisciplinary integrated care approach (i.e., nurse-led care along with usual specialist care) in AF patients is associated with reduced all-cause mortality and cardiovascular hospitalization.
Footnotes
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Study registration: PROSPERO registration number CRD42018110613
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Disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have reported no conflicts of interest.
