Addressing multimorbidity in elderly atrial fibrillation patients through interdisciplinary, tailored, patient-centered care pathways

Optimization of atrial fibrillation (AF) disease management is highly needed.

The AF prevalence is 7.8% above the age of 65-years and it will further increase as the population ages and predisposing factors become more prevalent. Multimorbidity (93.5%) and polypharmacy (76.5%) are very common in these patients. The mean number of comorbidities is 5.0 in those ≥65-years old.

There is a great need to optimize the management of AF patients - and not only the arrhythmia - to reduce the burden on patients, society, healthcare system and the economy.

The aim of the EHRA-PATHS project is to create well founded, innovative systematic care pathways to tackle multimorbidity in elderly AF patients.

We hypothesize that such a well-structured, interdisciplinary, and patient-tailored care program is feasible throughout all healthcare systems in Europe, and effective to optimize outcomes. There are 5 objectives:1.

Further characterize multimorbidity, polypharmacy and sex differences in AF patients by means of clinical data registries.2.

Perform a European needs assessment study to map current clinical practice and identify unmet needs concerning multimorbid AF patient management.3.

Devise and implement new software-supported interdisciplinary, patient-centred care pathways to detect, manage, and follow-up on multimorbidity and polypharmacy in elderly AF patients with a focus on each patient’s unique profile.4.

A two-part evaluation with an initial base mapping followed by a European cluster randomised controlled trial to evaluate the newly developed holistic care paths with predefined key performance indicators. A cost-utility analysis will be included.5.

Disseminate the insights, care pathways and implementation strategy from this project to patients, physicians, hospitals, other healthcare providers and regulatory authorities.The consortium combines extensive expertise from multiple specialties with the support of ESC and EHRA to impact outcomes of multimorbid AF patients.