COMPLIANCE WITH QUALITY ASSESSMENT CRITERIA FOR PATIENTS WITH ATRIAL FIBRILLATION AT THE OUTPATIENT STAGE

Highlights

For the first time, the fulfillment of criteria for assessing the quality of management of patients with atrial fibrillation at the outpatient stage and their contribution to the impact on the endpoints after a year of follow-up was analyzed. On average, at least 5 quality criteria are met in more than 50% of patients. The hypothesis of the predictor of CC for outcomes after one year has not been confirmed by endpoints (emergency calls p = 0.967; death from CVD p = 0.179; TIA p = 0.383; all deaths p = 0.220). The possibility of using 6 quality criteria as a diagnostic feature in the presence of paroxysmal AF with a sensitivity of 93.3 was found %; the specificity is 39.7%.

Aim. To study the clinical and functional characteristics of patients with AF followed in primary healthcare, and to assess the effectiveness of DO for patients with AF after one year of outpatient follow-up based on endpoints such as the frequency of EMS calls, CVD hospitalizations, CVD death, and death from other causes, depending on adherence to QC.

Methods. The study included 108 patients with non-valvular AF. All patients underwent a general clinical examination, assessment of adherence to QC, selection of a heart rate (HR) control strategy, therapy adjustment, patient education, and recommendations for further follow-up. After one year of DO, the patient was invited for a follow-up appointment with a cardiologist. Over the year, data on newly diagnosed diseases, EMS calls, hospitalizations due to CVD, frequency of TIA, deaths and their causes were collected in the information system.

Results. A comprehensive characterization of patients with AF is presented, including clinical, functional, and instrumental characteristics, and the frequency of adherence to QC according to regulatory documents. Out of 13 assessed QC at the outpatient stage, 5 were met in 50% of patients, and more than 5 QC were met in 50% of patients. The hypothesis about the possibility of using QC as predictors of outcomes after 1 year of follow-up (such as EMS calls, CVD hospitalizations, CVD deaths, and others) was tested. This hypothesis was not confirmed. According to the results of the analysis of the frequency of endpoint development in the groups with and without compliance with the CC, no significant differences were found the results for endpoints were as follows: frequency of EMS calls (p = 0.967), CVD hospitalizations (p = 0.725), CVD death (p = 0.179), development of TIA (p = 0.383), all-cause mortality (p = 0.220). In the group of patients with adherence to 5 or fewer QC, hospitalizations during the subsequent year were statistically significantly more frequent (p = 0.015).

Conclusion. On average, no fewer than 5 QC are met. When assessing endpoints, no statistically significant association with the number of QC is observed. Patients with AF for whom 5 or fewer QC were met on an outpatient basis are hospitalized due to CVD more often during the one-year follow-up period

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