The SAFETY Clinical Trial: Intensive Outpatient Follow-up to Improve Outcomes after Hospitalization for Atrial Fibrillation

The prevalence of atrial fibrillation (AF) is increasing with a concurrent rise in the number of hospitalizations for AF. The standard versus atrial fibrillation-specific management strategy (SAFETY) trial sought to test a nurse-led intervention following hospital discharge for chronic, non-valvular AF on patient outcomes of unplanned admission or all-cause death. Participants in the intervention arm received Holter monitoring and a home visit from a cardiac nurse within one to two weeks after discharge to tailor management of AF and comorbid disorders. After a median of 905 days of follow-up, 127 (76%) patients receiving the SAFETY intervention reached the primary endpoint compared to 137 (82%) patients receiving standard management (hazard ratio 0.97, 95% CI 0.76–1.23; p=0.85). When assessed as the proportion of the actual compared to the maximum possible number of days alive and not hospitalized, the SAFETY arm had a median of 900 (IQR 767–1025) of 937 maximum event-free days versus 860 (IQR 752–1047) of 937 maximum event-free days for the standard treatment group (effect size 0.22, 95% CI 0.21–0.23; p=0.04). There were no differences between groups in hospitalizations for AF, cardioversions, falls, bleeding events, acute coronary syndrome, or cerebrovascular events.

Conclusions

A nurse-led, home-based, multidisciplinary intervention among chronic AF patients following hospitalization improved the number of days alive and out of the hospital but not event-free survival or AF-specific secondary outcomes. However, the intensive nature of the intervention studied in the present trial may not be extensible to general practice.

Summarized by Jehu S. Mathew and Steven M. Bradley

  • Stewart S, Ball J, Horowitz JD, Marwick TH, Mahadevan G, Wong C, Abhayaratna WP, Chan YK, Esterman A, Thompson DR, Scuffham PA, Carrington MJ. Standard versus atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent admission and prolong survival: pragmatic, multicentre, randomised controlled trial. Lancet. 2014 Nov 17. pii: S0140-6736(14)61992-9.