Table 3.
Describing the current multimorbid AF management in Europe comparing the top six responding countries and other countries
| n = (%) | Total sample | Top six responding countries (n = 223) | Other countries (n = 118) | P-value |
|---|---|---|---|---|
| Typical numbers of patients seen with AF per month | ||||
| <20 | 47 (13.9) | 27 (12.1) | 20 (16.9) | |
| 20–50 | 169 (49.9) | 119 (53.4) | 51 (43.2) | |
| 51–100 | 87 (25.7) | 54 (24.2) | 33 (28.0) | 0.46 |
| 101–150 | 19 (5.6) | 13 (5.83) | 7 (5.93) | |
| >150 | 17 (5.0) | 10 (4.48) | 7 (5.93) | |
| What specialized outpatient services are available at your centre? | ||||
| Atrial fibrillation | 174 (51.3) | 112 (50.2) | 63 (53.4) | 0.58 |
| Heart failure | 249 (73.5) | 172 (77.1) | 75 (63.6) | 0.008* |
| Hypertension | 134 (39.5) | 90 (40.4) | 44 (37.3) | 0.62 |
| Diabetes | 177 (52.2) | 125 (56.1) | 52 (44.1) | 0.04* |
| Lipid | 138 (40.7) | 88 (39.5) | 50 (42.4) | 0.60 |
| Anticoagulation | 142 (41.9) | 96 (43.0) | 46 (39.0) | 0.47 |
| Syncope | 106 (31.3) | 73 (32.7) | 33 (28.0) | 0.35 |
| Chest pain | 146 (43.1) | 100 (44.8) | 47 (39.8) | 0.37 |
| Palpitations/arrhythmia/resynchronization | 148 (43.7) | 102 (45.7) | 44 (37.3) | 0.13 |
| Sleep apnoea | 110 (32.4) | 76 (34.1) | 34 (28.8) | 0.32 |
| Comprehensive geriatric assessment (dementia, falls, frailty, etc.) | 116 (34.2) | 80 (35.9) | 34 (28.8) | 0.19 |
| Other: | 17 (5.0) | |||
| 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) | 7 (3.14) | 12 (10.2) | 0.007* |
| What proportion of patients with comorbidities are referred to other specialty services? | 201 | 102 | ||
| >80% | 7 (2.1) | 4 (1.99) | 3 (2.94) | |
| 61–80% | 12 (3.5) | 5 (2.49) | 7 (5.93) | |
| 41–60% | 55 (16.2) | 30 (13.5) | 25 (24.5) | 0.004* |
| 20–40% | 104 (30.7) | 66 (29.6) | 40 (39.2) | |
| <19% | 123 (36.3) | 96 (47.8) | 27 (26.5) | |
| No response | 38 (11.2) | |||
| What is the reason for this referral rate? | ||||
| That is the number that needs referring | 151 (44.5) | 102 (50.7) | 49 (48.0) | |
| Resourcing issue so I need to be selective and prioritize | 61 (18.0) | 47 (23.3) | 14 (13.7) | 0.05 |
| There is an established process with the relevant specialties | 73 (21.5) | 40 (19.9) | 33 (32.4) | |
| Other: | 16 (4.7) | 11 (5.47) | 6 (5.88) | |
| 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 impact patient outcomes? | ||||
| Lack of integrated model of care for complex patients with AF | 174 (51.3) | 122 (54.7) | 53 (44.9) | 0.09 |
| Lack of evidence-based guidelines | 41 (12.1) | 29 (13.0) | 12 (10.2) | 0.44 |
| Lack of applicability of guidelines to my current practice | 31 (9.1) | 20 (8.97) | 11 (9.32) | 0.91 |
| Lack of time | 123 (36.3) | 83 (37.2) | 40 (33.9) | 0.54 |
| Organizational/Institutional | 145 (42.8) | 101 (45.3) | 44 (37.3) | 0.16 |
| Insurance/financial reasons | 43 (12.7) | 33 (14.8) | 11 (9.32) | 0.15 |
| Patient adherence/compliance | 126 (37.2) | 77 (34.5) | 50 (42.4) | 0.15 |
| Treatment-related adverse events | 36 (10.6) | 23 (10.3) | 13 (11.0) | 0.84 |
| 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 | 1 | |||
| Access/Availability of complex interventions/diagnostics | 2 | |||
| Patient choice/autonomy | 1 | |||
| 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; POTS, postural orthostatic tachycardia syndrome. *p < 0.05.