(P136) QUALITY OF LIFE OF PATIENTS WITH ATRIAL FIBRILLATION ENROLLED IN A KNOWLEDGE TRANSLATION AND INTEGRATED NURSE-LED CARDIOVASCULAR CARE PROGRAM: INSIGHTS FROM THE INTEGRATE AF PROGRAM

Background: Integrated atrial fibrillation (AF) care has been associated with better cardiovascular outcomes in patients with AF. However, the impact of integrated AF care on quality of life (QOL) outcomes has not been determined. We aim 1) to assess whether integrated AF care and knowledge translation (KT) over one year can improve the QOL of patients with AF and 2) to validate a visual analog scale (VAS) QOL for AF.

METHODS AND RESULTS: We conducted the INTEGRATE program, a transdisciplinary integrated knowledge translation (KT) and nurse-led AF care program, across 13 hospitals in Quebec, Canada (years 2012-2014). We enrolled patients with at least one episode of documented AF at least one year before enrolment. We conceived a VAS QOL whereby participants would determine subjectively their global QOL. We also assessed VAS QOL and the “Canadian Cardiovascular Society’s Atrial fibrillation” (CCSAF) score at baseline and at one-year.
Our cohort consisted of 1,487 patients with a mean age of 67.5+-11.2 years; 43% were females. Nineteen percents had diabetes mellitus (DM), 12% had prior stroke and 51% had paroxysmal AF. The VAS QOL at baseline was 70.9±17.0 At one year, patients experienced improvement in VAS QOL score with a mean of difference of +5.2 (95% Confidence Intervals: 4.1-6.1) from baseline [p < 0.0001]. There was significant improvement across all subgroups: women: +5.2 (CI: 4.1-6.1) [p < 0.0001], patients with DM +4.3 (CI: 2.3-6.3) [p < 0.0001], hypertension: +5.7 (CI: 4.4-6.9) [p < 0.0001;], heart failure: +7.9 (CI: 4.8-10.9) [p < 0.0001;], persistent AF: +4.7 (CI: 3.2-6.2) [p < 0.0001], and prior stroke:+3.6 (CI: 1.1-6.1) [p=0.005]. The mean CCS-AF score was 1.3±1.2 at baseline and 0.8±0.8 at one-year (change of -0.35±1.2, p< 0.0001). After adjusting for baseline QOL, the independent predictors of increase in QOL were hypertension, stroke, CHADs2 score, and heart failure. One-year CCS-AF score also improved in 25.0% proportion of patients (Figure 1). There was moderate negative correlation between VAS QOL and CCS-AF scores (spearman rank correlation coefficient -0.39, CI -0.34 – 0.44; p< 0.0001).

Conclusion: Patients who received one year of integrated transdisciplinary nurse-led KT and AF care had better QOL than baseline. This improvement was consistently observed across all subgroups of patients. Our findings suggested that integrated transdisciplinary nurse-led KT and AF care should be offered all patients with AF.