Integrated Approach in Frail Older People with Atrial Fibrillation

NCT ID: NCT06775028

Last Updated: 2025-01-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

1250 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-04-11

Study Completion Date

2026-01-31

Brief Summary

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The study will verify if a structured multidisciplinary approach (called iABC), aimed to improve the appropriate management of elderly AF patients with multimorbidity (the i-ABC group), would provide a clear evidence of an improvement in clinical conditions and quality of life compared to usual clinical care. The i-ABC group in AFFIRMO will follow the ABC pathway, focused on three domains: avoid stroke with anticoagulation (with optimized VKA or label-adherent DOAC use); better symptom management; and optimized management of associated cardiovascular and non cardiovascular comorbidities.

The study will be conducted in Bulgaria, Denmark, Italy, Romania, Serbia and Spain .

Detailed Description

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Controlled study, testing a structured implementation of an appropriate management of elderly AF patients with multimorbidity in clinical practice (adapting the ABC pathway and integrating the means of CGA) versus usual care; it is designed to provide reliable evidence of an active holistic integrated management approach to a common, multimorbid and 'high risk' clinical condition.

AFFIRMO use a novel platform (iABC) in a cluster randomized trial design, randomizing centres to iABC versus usual care.

Centres will be selected in each participating country (Bulgaria, Denmark, Italy, Romania, Serbia and Spain) under the responsibility of National Coordinators on the basis of a demonstrated interest in managing patients with AF. The 8-10 participating clusters in each country (see study size below) will be randomized in a 1:1 ratio to receive a quality-improvement intervention (iABC, experimental group) or 'usual care' practice (control group). The randomization will occur in each Country once all clusters selected in the Country have obtained IRB approval. The allocation schedule for random assignment of care models (iABC or usual care) to sites will be computer generated at the Central Coordinating Centre. The clusters in each Country will be stratified in 2 groups: Centres with or without interventional electrophysiology laboratory for AF ablation.

Conditions

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Atrial Fibrillation (AF) Hypertension Coronary Arterial Disease (CAD) Heart Failure COPD Peripheral Arterial Disease CKD Diabetes Mellitus Stroke TIA (Transient Ischemic Attack)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Cluster randomized trial
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Quality-improvement intervention (iABC)

The novel platform (iABC) that will be used in AFFIRMO will consist of an educational program, a healthy or functional diet/physical activity, guideline-adherent drug treatments, periodic (re)assessment.

iABC will provide guidance to obtain a more personalized care to AF patients in the experimental cluster implementing specific strategies to obtain clinical control for all the three pillars of the ABC pathway. During the entire follow-up the physician will be able to check the data imputed by the patients and, eventually, contact the patient to provide recommendations and to discuss changes to the treatments and lifestyle habits.

Group Type EXPERIMENTAL

iABC platform use

Intervention Type OTHER

The novel platform (iABC) that will be used in AFFIRMO will consist of an educational program, a healthy or functional diet/physical activity, guideline-adherent drug treatments, periodic (re)assessment.

Usual care

Patients followed in the centers randomized to the control arm will be managed by usual care in accordance with local clinical guidance

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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iABC platform use

The novel platform (iABC) that will be used in AFFIRMO will consist of an educational program, a healthy or functional diet/physical activity, guideline-adherent drug treatments, periodic (re)assessment.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Outpatients of both sexes with age ≥65 years;
* First diagnosed, paroxysmal, persistent, long-standing persistent or permanent AF, confirmed as per guideline-recommended diagnostic criteria for AF, e.g. with electrocardiogram (ECG) or Holter monitoring;
* ≥1 additional long-term comorbidity, thus fulfilling the definition of multimorbidity: hypertension (treated with at least 2 antihypertensive drugs), coronary artery disease (CAD), peripheral artery disease, heart failure, stroke/TIA, diabetes mellitus, COPD, CKD.

Exclusion Criteria

* Mechanical prosthetic heart valve or moderate/severe mitral stenosis;
* Patient unwilling to be enrolled and sign written informed consent;
* Patient unable to understand the study and attend the follow-up;
* Serious diseases with a life expectancy inferior to 12 months;
* Patients included in other interventional studies.

Only for sites randomized to the iABC group:

\- Patient without a device suitable for iABC use.
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Aalborg University

OTHER

Sponsor Role collaborator

Faculty of Medicine, University of Belgrade

UNKNOWN

Sponsor Role collaborator

Universidad de Murcia

OTHER

Sponsor Role collaborator

Carol Davila University of Medicine and Pharmacy

OTHER

Sponsor Role collaborator

Plovdiv Medical University

OTHER

Sponsor Role collaborator

University of Liverpool

OTHER

Sponsor Role collaborator

Heart Care Foundation

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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MHAT Haskovo AD-Cardiology

Haskovo, , Bulgaria

Site Status RECRUITING

SHATS Sveti Georgi - Pernik-Cardiology

Pernik, , Bulgaria

Site Status RECRUITING

MBAL Sv. Ivan Rilski-Cardiology

Plovdiv, , Bulgaria

Site Status RECRUITING

UMBAL Sveti Georgi EAD-Clinic of Cardiology

Plovdiv, , Bulgaria

Site Status RECRUITING

UMHAT Pulmed Plovdiv-Cardiology

Plovdiv, , Bulgaria

Site Status RECRUITING

Acibadem City Clinic Tokuda Hospital-Dept of Electrophysiology Clinic of Cardiology

Sofia, , Bulgaria

Site Status RECRUITING

Acibadem City Clinic UMBAL Cardiovascular Center-CARDIOLOGY

Sofia, , Bulgaria

Site Status RECRUITING

National Heart Hospital-ICCU

Sofia, , Bulgaria

Site Status RECRUITING

Herlev Hospital-Department of Cardiology

Herlev, , Denmark

Site Status RECRUITING

North Denmark Regional Hospital-Department of Cardiology

Hjørring, , Denmark

Site Status RECRUITING

Horsens Regional Hospital-Department of Medicine

Horsens, , Denmark

Site Status RECRUITING

Silkeborg Regional Hospital-Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways

Silkeborg, , Denmark

Site Status RECRUITING

Azienda Ospedaliera S. Anna E S. Sebastiano-Cardiologia Clinica Universitaria

Caserta, CE, Italy

Site Status RECRUITING

Ospedale Santa Maria Nuova-Cardiologia - Firenze 1

Florence, FI, Italy

Site Status RECRUITING

Als Genovese Palazzo Della Salute-Cardiologia Quarto

Genova, GE, Italy

Site Status RECRUITING

Ospedale Della Misericordia-U.O. Di Cardiologia

Grosseto, GR, Italy

Site Status RECRUITING

Fondazione Irccs San Gerardo Dei Tintori - Ospedale San Gerardo - U.O.C. Cardiologia

Monza, MB, Italy

Site Status RECRUITING

Istituti Clinici Scientifici Maugeri Irccs Sede Di Milano-Uo Cure Subacute

Milan, MI, Italy

Site Status RECRUITING

Ospedale Civile 'Guglielmo Da Saliceto'-Uoc Cardiologia E Utic

Piacenza, PC, Italy

Site Status RECRUITING

Ospedale Gubbio-Gualdo Tadino-U.O. Di Utic E Cardiologia

Gubbio, PG, Italy

Site Status RECRUITING

Policlinico Umberto Primo-Medicina Interna E Immunologia Clinica

Roma, RM, Italy

Site Status RECRUITING

Azienda Ospedaliera Santa Maria-Medicina Interna

Terni, TR, Italy

Site Status RECRUITING

Pou "Santa Maria Della Misericordia"-S.O.C. Cardiologia

Udine, UD, Italy

Site Status RECRUITING

Aou Federico Ii-Medicina Metabolico-Riabilitativa

Napoli, , Italy

Site Status RECRUITING

Spitalul Clinic Colentina-Cardiology

Bucharest, , Romania

Site Status RECRUITING

Spitalul Clinic Colentina-Internal Medicine

Bucharest, , Romania

Site Status RECRUITING

Spitalul Clinic Coltea-Internal Medicine and Cardiology

Bucharest, , Romania

Site Status RECRUITING

Spitalul Clinic de Urgenta 'Bagdasar-Arseni'-Cardiology

Bucharest, , Romania

Site Status RECRUITING

Spitalul Clinic de Urgenta Bucuresti-Cardiology

Bucharest, , Romania

Site Status RECRUITING

Spitalul Clinic Prof.Dr.Th.Burghele-Internal Medicine and Cardiology

Bucharest, , Romania

Site Status RECRUITING

Spitalul Universitar de Urgenta Elias-Cardiology

Bucharest, , Romania

Site Status RECRUITING

Spitalul Universitar de Urgenta Militar Central Dr. Carol Davila-Cardiac Function Laboratory

Bucharest, , Romania

Site Status RECRUITING

Institute for Cardiovascular Diseases Dedinje-Pacemaker and electrophysiology department

Belgrade, , Serbia

Site Status RECRUITING

KBC Bezanijska Kosa-Cardiology Department

Belgrade, , Serbia

Site Status RECRUITING

KBC Zemun-Cardiology Department

Belgrade, , Serbia

Site Status RECRUITING

University Clinical Centre of Serbia-Department for cardiac arrhythmias

Belgrade, , Serbia

Site Status RECRUITING

University Clinical Centre of Serbia-Department for invasive electrophysiology

Belgrade, , Serbia

Site Status RECRUITING

University Clinical Centre of Serbia-Emergency centre

Belgrade, , Serbia

Site Status RECRUITING

University Clinical Centre of Kragujevac-Cardiology Department

Kragujevac, , Serbia

Site Status RECRUITING

University Clinical Centre of Nis-Cardiology Department

Niš, , Serbia

Site Status RECRUITING

Hospital General Universitario de Alicante Doctor Balmis-CARDIOLOGY

Alicante, , Spain

Site Status RECRUITING

Hospital General Universitario Santa Lucía-CARDIOLOGY

Cartagena, , Spain

Site Status RECRUITING

Hospital Valle del Guadalhorce-CARDIOLOGY

Cártama, , Spain

Site Status RECRUITING

Hospital General Universitario de Elche-CARDIOLOGY

Elche, , Spain

Site Status RECRUITING

Hospital Universitario Virgen de la Victoria-CARDIOLOGY

Málaga, , Spain

Site Status RECRUITING

Hospital Clínico Universitario Virgen de la Arrixaca-CARDIOLOGÍA

Murcia, , Spain

Site Status RECRUITING

Hospital General Universitario Reina Sofía-CARDIOLOGY

Murcia, , Spain

Site Status RECRUITING

Hospital Universitario San Juan de Alicante-CARDIOLOGY

Sant Joan d'Alacant, , Spain

Site Status RECRUITING

Hospital Universitario de Tarragona Joan XXIII-Cardiology

Tarragona, , Spain

Site Status RECRUITING

Pius Hospital de Valls-Cardiology

Valls, , Spain

Site Status RECRUITING

Countries

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Bulgaria Denmark Italy Romania Serbia Spain

Central Contacts

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Aldo P Maggioni, MD

Role: CONTACT

+390555101211

Facility Contacts

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ANTONY GOGOV, MD

Role: primary

KOSTADIN KICHUKOV, MD

Role: primary

KRASTYU PENCHEV, MD

Role: primary

MARIYA TOKMAKOVA, MD

Role: primary

VLADIMIR IVANOV, MD

Role: primary

VASSIL TRAYKOV, MD

Role: primary

ISKREN GARVANSKI, MD

Role: primary

ELENA KOSTOVA-DIMITROVA, MD

Role: primary

MORTEN K LAMBERTS, MD

Role: primary

ALBERT MARNI JOENSEN, MD

Role: primary

KAREN KAAE DODT, MD

Role: primary

LARS FROST, MD

Role: primary

Paolo Calabro', MD

Role: primary

Alessandro Paoletti Perini

Role: primary

Maria Luisa Biorci, MD

Role: primary

Luigi Addonisio, MD

Role: primary

Elena Pazzi, MD

Role: primary

Marco Proietti, MD

Role: primary

Daniela Aschieri, MD

Role: primary

+390523303209

Deborah Cosmi, MD

Role: primary

Stefania Basili, MD

Role: primary

Giacomo Pucci, MD

Role: primary

Marzia De Biasio, MD

Role: primary

Alberto Maria Marra, MD

Role: primary

ANCA RODICA DAN, MD

Role: primary

CRISTIAN RASVAN BAICUS, MD

Role: primary

ILINCA MIHAELA SAVULESCU-FIEDLER, MD

Role: primary

CRINA SINESCU, MD

Role: primary

ALEXANDRU SCAFA-UDRISTE, MD

Role: primary

ANA MARIA BALAHURA, MD

Role: primary

SERBAN BALANESCU, MD

Role: primary

SILVIU STANCIU, MD

Role: primary

DEJAN KOJIC, MD

Role: primary

MARIJA ZDRAVKOVIC, MD

Role: primary

RADOSAV VIDAKOVIC, MD

Role: primary

TATJANA POTPARA, MD

Role: primary

NEBOJSA MUJOVIC, MD

Role: primary

TANJA JOZIC, MD

Role: primary

STEFAN SIMOVIC, MD

Role: primary

TOMISLAV KOSTIC, MD

Role: primary

AMAYA GARCÍA-FERNÁNDEZ, MD

Role: primary

IGNACIO GIL-ORTEGA, MD

Role: primary

JORGE RODRÍGUEZ CAPITÁN, MD

Role: primary

ANTONIO GARCÍA-HONRUBIA, MD

Role: primary

ALEJANDRO ISIDORO PÉREZ CABEZA, MD

Role: primary

FRANCISCO MARIN, MD

Role: primary

TOMÁS VICENTE VERA, MD

Role: primary

JOSE MORENO ARRIBAS, MD

Role: primary

JOSÉ LUÍS FERREIRO-GUTIÉRREZ, MD

Role: primary

LEYDIMAR ADEL ANMAD SHIHADEH MUSA, MD

Role: primary

Other Identifiers

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K23

Identifier Type: -

Identifier Source: org_study_id

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