Table 2.
Describing the current multimorbid AF management in Europe comparing university academic hospitals and non-academic hospitals
| n = (%) | Total sample | University Hospital (198) | Non-university hospital (143) | P-value |
|---|---|---|---|---|
| Typical numbers of patients seen with AF per month | ||||
| <20 | 47 (13.9) | 22 (11.1) | 25 (17.5) | |
| 20–50 | 169 (49.9) | 102 (51.5) | 68 (47.6) | |
| 51–100 | 87 (25.7) | 56 (28.3) | 31 (21.7) | 0.20 |
| 101–150 | 19 (5.6) | 9 (4.5) | 11 (7.69) | |
| >150 | 17 (5.0) | 9 (4.5) | 8 (5.59) | |
| What specialized outpatient services are available at your centre? | ||||
| Atrial fibrillation | 174 (51.3) | 107 (54.0) | 67 (46.8) | 0.19 |
| Heart failure | 249 (73.5) | 145 (73.2) | 102 (71.3) | 0.70 |
| Hypertension | 134 (39.5) | 82 (41.4) | 52 (36.4) | 0.33 |
| Diabetes | 177 (52.2) | 107 (54.0) | 70 (49.0) | 0.35 |
| Lipid | 138 (40.7) | 85 (42.9) | 53 (37.1) | 0.28 |
| Anticoagulation | 142 (41.9) | 92 (46.5) | 50 (35.0) | 0.03* |
| Syncope | 106 (31.3) | 70 (35.4) | 36 (25.2) | 0.04* |
| Chest pain | 146 (43.1) | 95 (48.0) | 58 (40.6) | 0.03* |
| Palpitations/arrhythmia/resynchronization | 148 (43.7) | 93 (47.0) | 53 (37.1) | 0.07 |
| Sleep apnoea | 110 (32.4) | 68 (34.3) | 42 (29.4) | 0.33 |
| Comprehensive geriatric assessment (dementia, falls, frailty, etc.) | 116 (34.2) | 71 (36.0) | 43 (30.1) | 0.26 |
| Other | 17 (5.0) | 6 (3.03) | 13 (9.09) | 0.03* |
| Valvular heart disease clinic | 2 | |||
| Cardio-oncology services | 5 | |||
| Private health clinic | 1 | |||
| Cardiogenetic services | 3 | |||
| Cardiac rehabilitation services | 2 | |||
| Cardiac disease in the young | 1 | |||
| Pulmonology/pulmonary hypertension | 2 | |||
| Stroke services | 2 | |||
| Weight loss/Health promotion services | 2 | |||
| Pacemaker service | 1 | |||
| Post-COVID POTS | 1 | |||
| None—no specialized clinics available | 19 (5.6) | |||
| What proportion of patients with comorbidities are referred to other specialty services? | ||||
| >80% | 7 (2.1) | 3 (15.8) | 4 (2.80) | |
| 61–80% | 12 (3.5) | 7 (3.54) | 5 (3.50) | |
| 41–60% | 55 (16.2) | 32 (16.2) | 23 (16.1) | 0.80 |
| 20–40% | 104 (30.7) | 64 (32.3) | 42 (29.4) | |
| <19% | 123 (36.3) | 67 (33.8) | 56 (39.2) | |
| No response | 38 (11.2) | |||
| What is the reason for this referral rate? | ||||
| That is the number that needs referring | 151 (44.5) | 84 (42.4) | 67 (46.9) | |
| Resourcing issue so I need to be selective and prioritize | 61 (18.0) | 34 (17.2) | 27 (18.9) | |
| There is an established process with the relevant specialties | 73 (21.5) | 46 (23.2) | 27 (18.9) | 0.60 |
| Other: | 16 (4.7) | 8 (4.04) | 9 (6.29) | |
| Referral to GP for onwards referral to specialist services | 4 | |||
| Patients don’t want onwards referral (time, money, access) | 1 | |||
| Palliative Care/End of Life Care needs | 1 | |||
| Availability of services | 1 | |||
| Complexity | 2 | |||
| Need for hospitalization | 1 | |||
| Scope of Practice of non-medical providers | 1 | |||
| No response | 38 (11.2) | |||
| What are the barriers within your current practice which potentially impacts on patient outcomes? | ||||
| Lack of integrated model of care for complex patients with AF | 174 (51.3) | 115 (58.0) | 60 (42.0) | 0.003* |
| Lack of evidence-based guidelines | 41 (12.1) | 23 (11.6) | 18 (12.6) | 0.79 |
| Lack of applicability of guidelines to my current practice | 31 (9.1) | 19 (9.60) | 12 (8.39) | 0.70 |
| Lack of time | 123 (36.3) | 73 (36.9) | 50 (35.0) | 0.72 |
| Organizational/Institutional | 145 (42.8) | 87 (43.9) | 58 (40.6) | 0.53 |
| Insurance/financial reasons | 43 (12.7) | 22 (11.1) | 22 (15.4) | 0.25 |
| Patient adherence/compliance | 126 (37.2) | 65 (32.8) | 62 (43.4) | 0.04* |
| Treatment-related adverse events | 36 (10.6) | 20 (10.1) | 16 (11.2) | 0.75 |
| Other | 21 (6.2) | |||
| The results of poor patient health choices | 1 | |||
| Relations between Cardiology and primary care providers | 2 | |||
| Competence of Primary Care providers | 2 | |||
| No changes to clinical practice Access/Availability of complex interventions/diagnostics | 1 | |||
| Patient choice/autonomy | 2 | |||
| Capacity in associated medical specialties | 1 | |||
| Lack of evidence-based guidelines for complexity (e.g. AF in cancer care) | 1 | |||
| DOAC reimbursement issues | 1 | |||
| More specialized AF clinicians | 1 | |||
| No barriers | 7 | |||
AF, atrial fibrillation; DOAC, direct oral anticoagulants; GP, general practitioner; and POTS, postural orthostatic tachycardia syndrome. *p < 0.05.