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A proposal for interdisciplinary, nurse-coordinated atrial fibrillation expert programmes as a way to structure daily practice.

Atrial fibrillation (AF) is a frequently occurring arrhythmia that is independently related to increased morbidity and mortality. In particular, AF is associated with complications such as ischaemic stroke, systemic thrombo-embolism, and heart failure, leading to increased hospitalizations.1 Atrial fibrillation, therefore, has a major impact on healthcare systems, which is likely to expand in an ageing population.1–3

Although AF can occur asymptomatically, two-thirds of the patients experience symptoms. The management of AF is, besides stroke prevention, predominantly focused on controlling symptoms and on improving quality of life (QOL).1,2,4 Symptom profile and burden can vary over time, both within and between patients. Consistent symptom assessment and follow-up are therefore important. Moreover, evidence-based guidelines facilitate clinicians in obtaining positive patient outcomes.1,2,5,6 Nonetheless, guideline adherence in practice is often poor,7 leading to suboptimal symptomatic control, reduced benefit from proven treatments on morbidity and mortality, and inappropriate healthcare resource use.

Recognizing that symptom management and improving guideline adherence are important both for patients individually and for the impact on healthcare systems globally, it is mandatory to develop and implement more efficient ways to deal with AF.6,8,9 However, the best model for implementing AF care is still unclear. This article presents our viewpoint regarding optimized AF management by comprehensively addressing (i) the main goals to be achieved; (ii) the related requirements for AF management programmes to achieve those goals; (iii) our position that nurses should have an important coordinating role in such programmes; (iv) the implementation of such programme in practice; and (v) which outcomes should be targeted to evaluate effective deployment.

Atrial fibrillation care should be organized to achieve clearly defined outcomes.10 As AF management is aimed at reducing symptoms and preventing …