Promoting Integrated Care for Atrial Fibrillation in Australia

By Sumudu Hewage, AusHSI PhD Scholar

What are the chances that a patient with atrial fibrillation living in Australia is routinely offered the best evidence-based care? When we consider the latest evidence, unfortunately not great. Current evidence for managing atrial fibrillation promotes the adoption of integrated care, which relies on different parts of the health system working together to deliver patient-centered care. For example, the European Society of Cardiology recommends the ABC pathway for integrated care in atrial fibrillation: A to avoid stroke, B for better symptom management and C for cardiovascular and other co-morbidity risk management such as regular exercise, optimal diet and stopping smoking.

Unfortunately, in Australia, the different care services involved in managing atrial fibrillation are not well coordinated. As a result, integrated care is not routinely offered to patients. My PhD will generate new evidence to support the implementation of routine integrated care for atrial fibrillation in Australia.

In my first PhD study, I wanted to understand the proportion of stroke patients with atrial fibrillation that could have been prevented with appropriate management. To do this, I estimated the preventable disease burden of ischaemic stroke, which is one of the major adverse events experienced by individuals with atrial fibrillation. As a result of this analysis, we now know that in 2019 in Australia, nearly 20,000 patients with atrial fibrillation either died before celebrating their 65th birthday or lived with a disability due to ischaemic stroke. Another interesting finding was that high-income countries, despite having the highest burden of atrial fibrillation, have managed to successfully reduce their ischaemic stroke burden compared with other regions. I’m now researching how these countries have efficiently coordinated different care services to offer integrated care, to understand how these practices can be best applied in Australia.

In addition to health system characteristics, a key factor impacting the sustainability of a healthcare intervention is its patient-centeredness. The next step in my PhD is to use a discrete choice experiment study to elicit how patients with atrial fibrillation living in Australia prefer to have care services delivered to them. Preferences learned from this study, along with system characteristics, will help a panel of experts select an integrated care model that fits best with the local health system.

Adverse outcomes among individuals with atrial fibrillation can potentially be prevented by improving access to integrated care, leading to reduced disease burden and lower costs incurred by the health system. To assist decision makers, the final stage of my PhD will evaluate the cost-effectiveness of the selected integrated care model compared to routine care.

New evidence generated by my PhD will help decision makers to invest in a sustainable integrated model of care to support patients with atrial fibrillation in Australia. By making this investment, the chances of a patient being routinely offered the best available care in the future will be much higher than they are now!