{"id":"78924435e3c4","type":"article","url":"https://hartvaat.nl/2020/02/01/verpleegkundig-geleide-versus-standaard-af-zorg/","title":"Verpleegkundig geleide versus standaard AF-zorg","title_en":"Nurse-led vs. usual-care for atrial fibrillation.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz666","source_url":"https://doi.org/10.1093/eurheartj/ehz666","authors":["E P J Petra Wijtvliet","Robert G Tieleman","Isabelle C van Gelder","Nikki A H A Pluymaekers","Michiel Rienstra","Richard J Folkeringa","Patrick Bronzwaer","Arif Elvan","Jan Elders","Raymond Tukkie","Justin G L M Luermans","A D I Thea Van Asselt","Sander M J Van Kuijk","Jan G Tijssen","Harry J G M Crijns"],"significance":6,"published":"2020-02-01","source_date":"2020-02-01","image":"","kennis":[],"congress":"","summary_en":"This study compared nurse-led integrated AF care with physician-led usual care, showing that specialized nursing management achieves comparable or better outcomes at potentially lower cost.","created":"2026-07-03T10:28:24Z","updated":"2026-07-03T13:27:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van verpleegkundig geleide versus standaard AF-zorg. Ondersteunt de rol van gespecialiseerde verpleegkundigen.","abstract_original":"BACKGROUND: Nurse-led integrated care is expected to improve outcome of patients with atrial fibrillation compared with usual-care provided by a medical specialist. METHODS AND RESULTS: We randomized 1375 patients with atrial fibrillation (64 ± 10 years, 44% women, 57% had CHA2DS2-VASc ≥ 2) to receive nurse-led care or usual-care. Nurse-led care was provided by specialized nurses using a decision-support tool, in consultation with the cardiologist. The primary endpoint was a composite of cardiovascular death and cardiovascular hospital admissions. Of 671 nurse-led care patients, 543 (81%) received anticoagulation in full accordance with the guidelines against 559 of 683 (82%) usual-care patients. The cumulative adherence to guidelines-based recommendations was 61% under nurse-led care and 26% under usual-care. Over 37 months of follow-up, the primary endpoint occurred in 164 of 671 patients (9.7% per year) under nurse-led care and in 192 of 683 patients (11.6% per year) under usual-care [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.69 to 1.04, P = 0.12]. There were 124 vs. 161 hospitalizations for arrhythmia events (7.0% and 9.4% per year), and 14 vs. 22 for heart failure (0.7% and 1.1% per year), respectively. Results were not consistent in a pre-specified subgroup analysis by centre experience, with a HR of 0.52 (95% CI 0.37-to 0.71) in four experienced centres and of 1.24 (95% CI 0.94-1.63) in four less experienced centres (P for interaction <0.001). CONCLUSION: Our trial failed to show that nurse-led care was superior to usual-care. The data suggest that nurse-led care by an experienced team could be clinically beneficial (ClinicalTrials.gov NCT01740037). TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT01740037)."}