Atrial Fibrillation and Flutter
Conditions
Keywords
Education
Brief summary
The aim of this study is to evaluate the effect of targeted in-person and online education on cardiovascular outcomes of AF patients (inpatient and outpatient), compared with standard care. Several other parameters (i.e. knowledge level, quality of life, symptom burden, self-care capabilities, adherence to oral anticoagulation, and an evaluation of the educational efforts) will be studied. Cost-effectiveness and cost-utility will also be investigated. The main research hypothesis is that individualized education based on the knowledge gaps measured with the JAKQ (Jessa Atrial fibrillation Knowledge Questionnaire) in each individual patient (called 'targeted education') is superior when compared to current AF care, both from an efficacy perspective (evaluated by different outcome measures) and from a cost-effectiveness perspective.
Interventions
OTHEREducation
Education + Medication adherence monitoring + Feedback when low adherence
Sponsors
Fund for Scientific Research, Flanders, Belgium
Universiteit Antwerpen
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
AF patients will be divided in three groups: one group will have in-person education, the second group will have online education and the third group will receive standard AF care. Cardiovascular outcomes will be compared between these groups.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age ≥ 18 years 2. Patients in whom AF or atrial flutter is diagnosed with an electrocardiogram (12-lead, holter,…) 3. Patients who are capable to sign the informed consent.
Exclusion criteria
1. Not able to speak and read Dutch 2. Cognitive impaired (e.g. severe dementia) 3. Life expectancy is estimated to be less than 1 year. 4. Ongoing participation in another clinical trial. 5. Pregnant women
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cardiovascular events | Patients will be followed for a minimum of 18 months (=last included patient) to a maximum of 36 months (=first included patient). | The occurrence of a composite endpoint of cardiovascular death, cardiovascular hospitalizations (first and recurrent) and unplanned cardiovascular or neurological consultations (first and recurrent). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patients' satisfaction of the intervention will be assessed by a study specific Patient Reported Outcome Measure (PROM) questionnaire. | at 12 months in the intervention groups and 18 months in the standard care group. | The number of questions will depend on the specific group allocation, ranging from a minimum of 4 questions to a maximum of 20 questions. These questions assess patients' satisfaction and opinion about the education provided during the study. |
| (Un)planned cardiovascular and neurological visits | Patients will be followed for a minimum of 18 months (=last included patient) to a maximum of 36 months (=first included patient). | — |
| Cardiovascular emergency department visits | Patients will be followed for a minimum of 18 months (=last included patient) to a maximum of 36 months (=first included patient). | — |
| General practitioner visits | Patients will be followed for a minimum of 18 months (=last included patient) to a maximum of 36 months (=first included patient). | — |
| Patients' knowledge level, assessed by the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ) | at baseline, 1 month, 3-, 6-, 12- and 18 months and if applicable at 24-, 30- and 36 months or at the end of the study in the intervention groups. In the standard care group at 18 months and if applicable at the end of the study. | This questionnaire includes 16 knowledge questions: 8 about atrial fibrillation, 5 about oral anticoagulation medication and 3 about vitamine K antagonists or non-vitamin K antagonist oral anticoagulants. A total score between 0% and 100% will be generated in which 100% is the best possible score (all questions are answered correctly). |
| Patients' quality of life, assessed by the EQ-5D-3L questionnaire and the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Questionnaire. | at baseline, 3-, 12- and 18 months and if applicable at the end of the study in the intervention groups. In the standard care group at baseline and 18 months and if applicable at the end of the study. | The EQ-5D-3L descriptive system includes a total of 5 questions for 5 dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). Each question has 3 levels (no problems, some problems, and extreme problems). The EQ Visual Analogue Scale records the patient's self-rated health on a vertical visual analogue scale where the endpoints are labelled 'Best imaginable health state' (score of 100) and 'Worst imaginable health state' (score of 0). The AFEQT is an atrial fibrillation-specific health-related quality of life questionnaire based on 18 questions in the domain of symptoms, daily activities and treatment concerns. A treatment satisfaction score can be calculated based on 2 additional questions. All questions are rated on a 7 point Likert scale. A scoring key is used to determine an overall AFEQT score and a treatment satisfaction score ranging from 0 to 100. A lower score indicates a worse health-related quality of life. |
| Patients' symptom burden, assessed by the Leuven ARrhythmia Questionnaire (LARQ). | at baseline, 3-,12- and 18 months and if applicable at the end of the study in the intervention groups. In the standard care group at baseline and 18 months and if applicable at the end of the study. | The LARQ is based on 6 atrial fibrillation-related symptoms: palpitations, shortness of breath, chest pain, syncope, dizziness and fatigue. For each of these symptoms (except syncope), symptom prevalence, occurrence (frequency, duration, severity), distress, circumstances triggering the symptom, and effect on daily activities are requested. Subscale scores on five domains (symptom frequency, duration, effect on daily activities, severity and distress) are calculated by summing the raw scores and transforming them to a 0-100 scale. Higher scores represent a more pronounced symptom burden. |
| Patients' self-care capabilities, assessed by the Self-Care Questionnaire (SCQ) | at baseline, 3-,12- and 18 months and if applicable at the end of the study in the intervention groups. In the standard care group at baseline and 18 months and if applicable at the end of the study. | This questionnaire includes a total of 15 questions. The first 6 questions will be scored on a 1 to 5 Likert scale. 1 is the best score and 5 is the worst score. The other 9 questions measure evolutions of self-care capabilities over time. |
| Patients' adherence to medication (oral anticoagulation), measured by the Medication Events Monitoring System (MEMS). | monitoring between 0-3 months and 12-15 months and feedback during 3-6 months and 15-18 months in those patients with a low adherence in the intervention groups | — |
| Mortality | Patients will be followed for a minimum of 18 months (=last included patient) to a maximum of 36 months (=first included patient). | The occurrence of death will be followed. |
| (Un)planned hospital admissions | Patients will be followed for a minimum of 18 months (=last included patient) to a maximum of 36 months (=first included patient). | — |
| Hospital duration | Patients will be followed for a minimum of 18 months (=last included patient) to a maximum of 36 months (=first included patient). | The total number of hospitalization days during the follow-up period will be calculated. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Cost-effectiveness analysis | Patients will be followed for a minimum of 18 months (=last included patient) to a maximum of 36 months (=first included patient). | A cost-effectiveness analysis will be performed. |
| Cost-utility analysis | Patients will be followed for a minimum of 18 months (=last included patient) to a maximum of 36 months (=first included patient). | A cost-utility analysis will be performed. |
| Time investments | Patients will be followed for a minimum of 18 months (=last included patient) to a maximum of 36 months (=first included patient). | Time investments will be tracked (e.g. timing of the initiation session, the education sessions, feedback during medication telemonitoring). |
Countries
Belgium
Outcome results
None listed