Last updated on May 2019

Improving Atrial Fibrillation Specialty Care Delivery in Rural Communities

Brief description of study

This study evaluates a new model of specialty care for older adults in rural communities with Atrial Fibrillation (AF) compared to usual rural physician care. Half the participants will receive the new model of specialty care, the Virtual AF Clinic (vAFC), while the other half will receive usual care. The vAFC will combine usual care, telehealth appointments with AF specialized nurse practitioners/cardiologist, and an educational website. Participants will be recruited from rural physician offices and will be followed for 12 months collecting data at four time points on AF quality of life, AF knowledge, healthcare utilization (e.g., hospital/emergency department/physician visits), lifestyle behaviors (e.g., physical activity), and stroke/bleeding risk. This will generate evidence to determine the feasibility of scaling up the vAFC model to other sites.

Detailed Study Description

Chronic diseases and unhealthy behaviors are more prevalent in older adults in rural communities yet they have less access to healthcare, especially specialist care. This is problematic for the rising population of older adults with atrial fibrillation (AF) who have rapid disease progression, and increased risk of stroke, heart failure, and death. In rural communities with specialty care gaps, a virtually delivered AFC offers a viable cost effective option for older adults with AF compared to general practitioner (GP) care, given the complexity of AF patients with multiple co-morbidities and poor symptom control.

The purpose of phase 3 of this multi-phase study is to conduct a randomized controlled trial to test a newly developed virtual AF clinic in comparison to usual rural GP care.

Participants in the control group (usual care) will receive usual GP care in their rural communities. Usual care will include some combination of treatment, education, and support as per each GPs individual practice. Participants will also have contact with the research team during the four data collection time points (baseline, 3 months, 6 months, and 12 months).

Participants in the intervention group (vAFC) will receive usual GP care plus the vAFC which consists of telehealth appointments with Nurse Practitioner/Cardiologist and access to an AF specific educational website. It is anticipated the vAFC, as with the onsite clinic, will include up to a maximum of four scheduled telehealth appointments: an initial appointment following randomization, at 4-6 weeks, 3 months, and 6 months. Participants will attend appointments at their local hospital. Appointments will follow the usual protocol of the onsite AF clinic in Kelowna including, but not limited to, reviewing with patients their vital signs, tests (e.g., Echo, Holter, stress test), symptom management, concerns, and medications.

In addition to the telehealth appointments participants in the intervention group will also have access to an educational AF website. Following randomization participants will be given an orientation on how to access the website, its purpose, and a tour of the content. The website content is inclusive of topics specific to AF, such as; (1) What is AF, (2) Risk Factors, (3) Lifestyle, (4) Symptom Management, (5) Complications, (6) Frequently Asked Questions, and (7) Patient Stories. Content was developed and vetted by researchers and clinicians to ensure information is relevant, up to date, and evidence based. To promote and encourage website interaction, emails will be sent to participants once a month for the duration of the intervention with highlights and important messages from the website

Clinical Study Identifier: NCT03512483

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Recruitment Status: Open

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