AFFIRMO: ATRIAL FIBRILLATION INTEGRATED APPROACH

BACKGROUND

The prevalence of atrial fibrillation (AF) amongst Europe’s elderly population is growing. Associated with more severe strokes, AF is an abnormal heart rhythm with rapid and irregular beating. In the context of multimorbidity, improving the management of AF is vital and requires a holistic approach.

The novel approach underpinning the AFFIRMO project is to focus on clusters of multimorbidity where atrial fibrillation (AF) represents one of the chronic conditions. Improving the management of AF in the context of multimorbidity may benefit individuals on a larger scale, with a holistic approach to optimize clinical management of older AF patients taking into account the multifaceted aspects of individuals’ health, including multimorbidity, polypharmacy, personal preferences, and social context.

The challenge is to move from fragmentation to an integrated care strategy designed to be patient-centred. AFFIRMO’s answer to this challenge is to develop a holistic care approach based on the ‘Atrial Fibrillation Better Care'(ABC) model.

From a current fragmented approach

Multimorbidity is a common condition in older age and can substantially influence people’s health and quality of life, making management more difficult.

1 in 4 adults at risk of developing Atrial Fibrillation in their lifetime and is associated with a higher risk of stroke, death, dementia and heart failure.

To an integrated care pathway 

Patient Centered

AFFIRMO’s care pathway will account of personal preferences for treatment and considers the social context of patients.

Systemic

AFFIRMO’s care pathway will enable synergies and cooperation among the different health disciplines involved in the treatment of patients with multimorbidity.

Digital

AFFIRMO’s care pathway will rely on a digital platform developed to assist physicians in applying and tailoring a personalised care strategy.

OBJECTIVES

• Identify different clusters of multimorbidity in older patients with AF.
• Assess the needs of patients, caregivers, and health professionals for the comprehensive management of multimorbidity including AF, and to examine ways of optimizing care and self-management.
• Develop, implement and test the effectiveness of a patient-centred approach on older multimorbid AF patients in the clinical practice. We aim to adapt, implement and promote a care pathway, in older p
• Develop an interoperable care framework that can facilitate the application of this personalized care pathway, that bridges the continuum between primary and secondary care, with the active involvemen
• Model the impact of multimorbidity including AF on healthcare costs and the health economic benefits by the proposed integrated care pathway.
• Subgroup analyses would assess differences on outcomes of in relation to gender and social inequalities.

OUR TASKS IN THE PROJECT

Wp9 led by EngageMinds HUB: HEALTH EMPOWERMENT IMPLEMENTATION AND DISSEMINATION

This WP will achieve two main objectives: 

1. enabling empowerment initiatives dedicated to the different key stakeholders of the project (e.g., patients, caregivers and healthcare professionals) to improve their engagement in self-management, levels of literacy about AF and its treatment and empower them;
2. planning and delivering smart communication and dissemination activities to engage all the relevant stakeholders for the AFFIRMO project.

CONSORTIUM

A multidisciplinary consortium across Europe representing clinical research, epidemiology, data science, biostatistics, pharmacology, economics, psychology and social sciences.