Integrated care pathway

The current healthcare approach to multimorbidity is fragmented. AFFIRMO aims to move from fragmentation to an integrated pathway designed to be Patient-centred, Systemic and Digital

Patient-centered

AFFIRMO's care pathway will account of personal preferences for treatment and considers the social context of patients. The treatment strategy will be the result of a shared decision-making process.

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, based on open standards, developed to assist physicians in applying and tailoring a personalised care strategy.

The workplan

AFFIRMO’s integrated care pathway will focus on Atrial Fibrillation (AF), a cardiac arrhythmia associated with high risk of morbidity. The workplan is structured around three research areas:

Clusters of multimorbidity

Researchers will characterize how different patterns of multimorbidity are distributed within the population of older individuals with AF.

Combining multiple analysis techniques, the team will investigate the reciprocal relationships between the most common diseases and AF. Drug patterns and potential drug reactions will also be addressed.

Stakeholder involvement

The project will assess the needs of patients, caregivers, and health professionals for the comprehensive management of multimorbidity (including AF) and examines ways of optimizing care and self-management.

Data will be collected though surveys and interviews. The goal is to develop a set of quality performance indicators (QPIs) to support the co-designing process of the care approach proposed by AFFIRMO.

Integrated care pathway

AFFIRMO will develop, implement and test patient-cantered approach on older multimorbid AF patients in the clinical practice. The proposed approach will rely on a digital platform designed to bring patients, caregivers, and health professionals closer together through information sharing.

An international clinic study will be performed to assess the effectiveness of the AFFIRMO’s care approach. Researchers will also consider the economic dimension by identifying how the integrated pathway will impact health outcomes and costs.

Consortium

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

Exploring patient engagement in atrial fibrillation with multimorbidity: impact on quality of life, medication adherence and healthcare perceptions—a multicountry cross-sectional study

Bosio Caterina, Usta Dilara, Donato Leo, Trevisan Caterina, Lane Deirdre, Graffigna Guendalina, AFFIRMO project consortium

Objective To examine patient engagement (PE) levels of atrial fibrillation (AF) patients with multimorbidity, to identify distinct personas based on sociodemographic and clinical characteristics, as well as engagement levels, and to compare PE in disease management with health-related quality of life, medication adherence, and perceptions of care quality.

Design A cross-sectional survey.

Setting Data were collected through an online survey platform between 31 May 2022 and 31 January 2023 from five European countries (Denmark, Italy, Romania, Spain and the UK).

Participants The study involved 659 AF patients older than 18 years who were diagnosed with one or more concomitant chronic health conditions.

Primary and secondary outcome measures The survey focused on identifying the needs and quality performance indicators (QPIs) of patients. Emotional engagement was evaluated using the Patient Health Engagement Scale (PHE-s), and cognitive-behavioural engagement was assessed using the Altarum Consumer Engagement Measure (ACE). Engagement scores of each measure were grouped as high or low and compared by age group, sex, level of education and country of recruitment, health-related quality of life, medication adherence and perception of care quality using χ2 and Mann‒Whitney U tests (p<0.05).

Results Among the 659 AF patients (70.9±10.2 years, 52.8% female), 428 (65%) were categorised as having high emotional PE levels based on PHE-s and were significantly more likely to be <75 years old and male, have a secondary level of education or above, and have <3 comorbidities (p<0.05). Regarding the ACE scores, 369 (56%) were classified as having high cognitive-behavioural PE levels and were more likely to be <65 years old, reside in Northern Europe, have degree-level education or higher, and have <3 comorbidities (p<0.05). Additionally, participants with high emotional PE demonstrated better quality of life, medication adherence and perceptions of quality of care, whereas those with higher levels of cognitive-behavioural PE had better quality of life and perceptions of quality of care.

Conclusions From a clinical perspective, the findings highlight the need for a personalised approach sensitive to the expectations and needs of AF patients. The present research suggests that implementing sociodemographic and clinical profiling for AF patients could facilitate the formulation of improved care strategies.

PLOS ONE

Key needs, quality performance indicators and outcomes for patients with atrial fibrillation and multimorbidity: The AFFIRMO study

Donato Giuseppe Leo, Caterina Trevisan, Adele Ravelli,Trudie C. A. Lobban,Deirdre A. Lane on behalf of the AFFIRMO Study investigators

Background
Patients with atrial fibrillation (AF) often have concomitant long-term conditions that negatively impact their quality of life and the clinical management they receive. The AFFIRMO study aimed to identify the needs, quality performance indicators (QPIs), and outcomes relevant to patients, caregivers and healthcare professionals (HCPs) to improve the care of patients with AF.

 

Methods
An on-line survey to collect the key needs, QPIs, and outcomes relevant to patients with AF, their caregivers and HCPs, was distributed between May 2022 and January 2023 in five countries (UK, Italy, Denmark, Romania and Spain). Results from the on-line survey were discussed in a three-round Delphi process with international representatives of patients with AF, caregivers, and HCPs to determine the key needs, QPIs and outcomes for the management of patients with AF and multimorbidity.

 

Results
659 patients (47.2% males, mean (SD) age 70.9 (10.2) years), 201 caregivers (26.9%
males, mean (SD) age: 58.3 (SD 15.2) years), and 445 HCPs (57.8% males, mean (SD)
age 47.4 (10.6) years) participated in the survey. An initial list of 27 needs, 9 QPIs, and 17
outcomes were identified. Eight patients, two caregivers, and 11 HCPs participated in the Delphi process. Nineteen (70%) needs, 8 (89%) QPIs, and 13 (76%) outcomes reached
“consensus in”, and were included in the final list.

 

Conclusions
The final key needs, QPIs and outcomes obtained from the Delphi process will inform the
AFFIRMO clinical trial, which aims to test the iABC app which incorporates an empowerment toolbox for patients and their caregivers, providing information to improve patient engagement and empowerment to help improve the clinical and self-management of patients with AF in the context of multimorbidity.