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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Multidisciplinary team for antithrombotics management and clinical outcomes in older adults with atrial fibrillation:
Maïwenn Prunel1, Alexis Cochard1,2, Leila Abbas1
1Institut Pierre Louis d'Épidémiologie Et de Santé Publique (IPLESP), Sorbonne Université, INSERM, Paris, 75013, France.
Insights
Multidisciplinary team meetings for managing antithrombotics in older adults with atrial fibrillation (AF) did not reduce adverse outcomes. This approach showed no significant benefit in preventing death, thromboembolism, or major bleeding within six months.
Area of Science:
- Geriatric Medicine
- Cardiology
- Pharmacology
Background:
- International guidelines recommend multidisciplinary, patient-centered management for atrial fibrillation (AF), including antithrombotic therapy.
- The clinical effectiveness of multidisciplinary AF teams for complex, high-risk subgroups, such as the very old and frail, remains under investigation.
- Current evidence is lacking on the impact of dedicated antithrombotic management teams on clinical outcomes in elderly AF patients.
Purpose of the Study:
- To assess the impact of hospital multidisciplinary team (MDT) meetings focused on antithrombotic management.
- To evaluate the effect of MDT meetings on a composite outcome of death, major thromboembolic events, or major/clinically relevant bleeding.
- To determine the clinical benefit of MDT antithrombotic management in older adults (≥75 years) with AF over a 6-month follow-up period.
Main Methods:
- Prospective multicenter cohort study involving 818 patients aged ≥75 years with AF or atrial flutter.
- Target trial emulation approach (cloning, censoring, weighting) applied to observational data from five acute geriatric departments.
- Primary exposure: participation in a hospital MDT meeting (geriatricians, cardiologists, neurovascular specialists, hemostasis experts) within 45 days; 6-month follow-up.
Main Results:
- The study included 818 patients; 138 (16.9%) were in the MDT meeting arm (median age 89 years, 57% female).
- The 6-month cumulative incidence of the primary composite outcome was similar: 35.3% (MDT arm) vs. 36.2% (control arm).
- No significant difference was observed between the MDT and control arms for the primary composite outcome (risk difference -0.9%; 95% CI, -7.5 to 6.0; p=0.79).
Conclusions:
- Hospital multidisciplinary team meetings for antithrombotic management in older adults with AF did not reduce the composite outcome of death, major thromboembolism, or major bleeding.
- The findings suggest no significant clinical benefit from this specific MDT approach in this high-risk population within the study period.
- Results should be interpreted cautiously due to the observational design and potential for residual confounding.
Background:
Recent international guidelines emphasize a multidisciplinary, patient-centered approach to managing atrial fibrillation (AF), particularly regarding antithrombotic (antiplatelet and anticoagulant) management. These guidelines advocate establishing multidisciplinary AF teams, but the clinical benefits of this approach for high-risk, clinically complex subgroups-particularly among very old and frail patients-remain uncertain. Our objective was to evaluate the impact of a hospital multidisciplinary team meeting dedicated to antithrombotics management on a composite measure of all-cause death, major thromboembolic events, or major or clinically relevant bleeding within 6 months in older adults with AF.
Methods:
A prospective multicenter cohort study was conducted in five acute geriatric departments in the Paris area between May 2021 and January 2024. Using a target trial emulation approach (cloning, censoring, weighting strategies), outcomes were analyzed in patients aged ≥ 75 years with AF or atrial flutter, followed in the geriatric departments (via outpatient consultation or hospitalization; > 98% were hospitalized). Participants were followed for 6 months or until death. The primary exposure was a hospital multidisciplinary team meeting within 45 days of inclusion, involving geriatricians, cardiologists, neurovascular specialists, and hemostasis experts. Cumulative incidences were estimated using the reverse Kaplan-Meier method. RESULTS: The study included 818 patients, 138 (16.9%) in the hospital multidisciplinary-team meeting arm (median age 89 (Q1Q3 84-93), 57% female). The 6-month cumulative incidence of the primary composite outcome was 35.3% (95% CI, 29.6 to 41.8) in the multidisciplinary-team meeting arm and 36.2% (95% CI, 32.2 to 40.1) in the control arm (risk difference - 0.9 (95% CI, - 7.5 to 6.0); p = .79). The 2 arms did not differ in individual events within the composite measure.
Conclusions:
A hospital multidisciplinary team meeting dedicated to antithrombotics management in older adults with AF was not associated with a reduction in all-cause death, major thromboembolic events, or major or clinically relevant bleeding within 6 months. These findings should be interpreted with caution due to the observational design and potential for residual confounding.
Trial Registration:
ClinicalTrials.gov registration: NCT04932603.
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