NURSE-led care in Patients Undergoing CATheter Ablation for Atrial Fibrillation: The NURSECAT-AF randomized trial
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Background
Atrial fibrillation (AF) is associated with reduced quality of life and frequent hospitalizations. Integrated nurse-led care has proven beneficial in unselected AF patients, but evidence specific to patients undergoing catheter ablation is limited. We aimed to assess the impact of a structured nurse-led intervention in patients undergoing first-time AF ablation.
Methods
NURSECAT-AF was a single-center prospective randomized clinical trial comparing usual care (UC) with a nurse-led peri-ablation care (NLC) which incorporated an educational program on AF, peri-procedural support, and risk factor management. Consecutive patients without heart failure referred for first-time AF ablation were randomized to UC or NLC. Visits in NLC were scheduled at 15 days pre-ablation, and 15 days, 3 months and 6 months post-ablation. The primary endpoint was quality of life at 12 months post-ablation using the Arrhythmia-Specific Scale in Tachycardia and Arrhythmia (ASTA). Secondary outcomes included arrhythmia recurrence, readmissions and emergency visits, and symptom burden at one year, and AF knowledge and satisfaction at 3 months.
Results
Of 116 patients screened, 66 were randomized (33 per group; mean age 63±10 years; 67% male). At 12 months, the NLC group showed significantly better quality of life (baseline-adjusted ASTA difference +4 points [95%CI 1.8-6.3], p=0.007) than UC, and presented with less arrhythmia recurrences (OR 0.2 [95%CI 0.05-0.78]) and emergency visits (OR 0.2 [95%CI 0.06-0.66]). Patients assigned to NLC also presented with a lower symptom burden, higher satisfaction and greater disease knowledge. Risk factor profile was improved in the NLC group, with higher rates of smoking cessation, engagement in regular physical activity, and weight optimization. Nurse-led management enabled more frequently diagnosing obstructive sleep apnea.
Conclusion
Nurse-led, integrated care for patients undergoing AF ablation improves the quality of life, clinical outcomes and risk factor management at one year post-procedure. These findings support the incorporation of structured nurse-led interventions in the peri-ablation care pathway.
Clinical Trial Registration
NCT05333445.
https://clinicaltrials.gov/study/NCT05333445?term=NCT05333445&rank=1
GRAPHICAL ABSTRACT
(Annex B)
Clinical Perspective
What is known?
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Nurse-coordinated, integrated care pathways in patients with chronic conditions, including atrial fibrillation (AF), have been shown to improve patient-reported quality of life and to reduce all-cause and cardiovascular mortality.
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Atrial fibrillation ablation effectively decreases arrhythmic burden and enhances quality of life; nonetheless, recurrences remain common, and many patients continue to experience symptoms and diminished functional status.
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The role of periprocedural nurse-led management remains unknown.
What this study adds?
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In a randomized controlled trial, implementation of a periprocedural, nurse-led care model significantly improved quality of life in patients undergoing AF ablation, as assessed by validated symptom and well-being instruments.
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At one year post-ablation, the incidence of AF recurrence is reduced in the cohort receiving nurse-led care, an effect likely mediated by superior optimization of cardiovascular risk factors achieved through targeted nurse intervention.
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A comprehensive, nurse-delivered strategy—comprising patient education, systematic preparation for ablation, and proactive management of modifiable arrhythmia risk factors—confers meaningful clinical benefit in the management of AF.
