ESC and EHRA lead a path towards integrated care for multimorbid atrial fibrillation patients: the Horizon 2020 EHRA-PATHS project

Transforming health care is a difficult task: although physicians know which evidence-based treatments work, delivering those in a unified fashion as integrated management often lacks adequate implementation. European heart rhythm association (EHRA) and european society of cardiology (ESC) have been entrusted by the European Commission to lead a consortium with the aim to do just that. Atrial fibrillation (AF) usually is the expression of other diseases and/or its outcome is influenced by other conditions. In fact, 93.5% of AF patients have a least one additional comorbidity, and AF patients over 65 years old have an average of five comorbidities. 1-3 Therefore, AF needs to be considered as a blinking light that these comorbidities need to be addressed, which is a much more gargantuan task than just dealing with the arrhythmia itself and with anticoagulation. As a consequence of the multiple comorbidities, polypharmacy, defined as taking 5 different drugs concomitantly, is present in 76% of AF patients. 4 This obviously leads to challenges concerning correct adherence to drugs and treatments that have proven to improve prognosis and quality of life. The EHRA-PATHS project, which unites 14 partners throughout Europe and which is led by EHRA/ESC as coordinator (Figure 1) wants to 'address multimorbidity in elderly atrial fibrillation patients through interdisciplinary, patient-centred, systematic care pathways'. These pathways are not just cardiovascular, but span all disciplines that touch on the comorbidities that are seen in elderly AF patients. A unique feature of the consortium is that each partner involves another specialty than cardiology/arrhythmology, including general practioners. Figure 2 illustrates the work at hand. In the first work package (WP), the consortium wants to better delineate the magnitude and scope of the comorbidity and polypharmacy profile of AF patients, based on data that are available in the ESC-managed EORP database (European Observational Research Programme). 5,6 WP2 will perform a gap analysis to better understand the obstacles in different EU countries for the implementation of a systematic management approach. Obstacles can be resources-or training-related, or dependent on the health care organisation in different regions. The centrepiece of the project will consist of the development of a pragmatic management tool that helps the care team to carefully map each AF patient with his/her comorbidities. The basic concept is that comorbidities that have not been identified (ranging from hypertension and diabetes to sleep-disordered breathing) will never be therapeutically tackled. The approach should be as lean as possible. In WP3, different partners will (together with their affiliated non-cardiac disciplines) develop minimalistic diagnostic approaches and key identification parameters for different co-morbidities. Also, they will define target outcomes for the treatment of these comorbidities. These different care paths will later be integrated in an overall care path and management tool in WP4 (coordinated by Antwerp University Hospital). It explains the project name EHRA-PATHS. The consortium will look for IT implementations that are generic, hence, that can be linked to diverse health care systems in different countries and regions. It is beyond the scope of the project to evaluate whether such an approach is improving health outcomes. That is also not needed: indeed, practice recommendations like the ESC Guidelines on the Management of AF and others have defined which care should be given in order to improve outcomes. 7,8 What counts is whether such care is effectively delivered, which in turn depends on whether comorbidities have been identified in a systematic fashion. Moreover, measuring outcomes itself would require a clinical trial of a much different scope †

Publication year:2022

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