Putting SAFETY first

Published: Tuesday 18th November 2014

New research from the newly established Mary MacKillop Institute for Health Research has the potential to improve the lives of the estimated 800,000 Australians affected by atrial fibrillation – an often silent but potentially deadly condition that causes the heart to beat in a rapid and irregular manner.
In a world-first study (SAFETY), the results of which will be announced at a special session of an international heart conference in Chicago, with simultaneous publication in the prestigious journal The Lancet, the team from the MacKillop Institute examined the potential benefits of post discharge program of home visits and specialist care for those admitted to hospital with atrial fibrillation.
Without appropriate management, atrial fibrillation is often linked to deadly strokes, a high risk of repeated readmissions to hospital and a premature death.
Led by Professor Simon Stewart (the Director of the Institute), a team of nurses and doctors from three states tested their intervention specifically designed for patients with atrial fibrillation against standard post-discharge care.
As to be reported in their Lancet paper, the team found a marked improvement in the health of those exposed to the SAFETY Intervention as shown by a combination of fewer deaths and days of recurrent hospitalisation during a minimum of two years follow-up following the original hospital admission.
Key findings
Professor Stewart and the SAFETY Trial Investigators will announce that for every 100 patients with atrial fibrillation exposed to their world-first management program, the following benefits apply:

•    7 fewer deaths
•    1000 fewer days of costly hospital stay
•    1000 more days alive and out-of-hospital
•    Reduced health care costs amounting to more than $500,000
“We are proud to produce world-first evidence to show that we can improve the lives of the tens of thousands of typically older and vulnerable men and women discharged from hospital with this condition every year” said Professor Stewart.
“Given the enormous cost of managing this deadly and disabling condition, our findings have the potential to save the health care system millions of dollars if applied on a systematic basis”, he said.
Professor Stewart  announced the findings of the study on Monday 17 November (Tuesday 18 November AEDT) at the 2014 American Heart Association Scientific Sessions in Chicago. The research is to published in The Lancet on the same day, in a paper titled ‘Atrial fibrillation-specific management strategy (SAFETY) to reduce recurrent hospitalisation and prolong survival: a pragmatic, multicentre randomised controlled trial’.
Key points
•    Cardiovascular disease is one of the leading causes of death worldwide;
•    Almost 3.5 per cent of the Australian population is reported to have atrial fibrillation (AF);
•    AF is closely linked to debilitating and deadly strokes and heart failure;
•    The annual rate of hospitalisation for AF patients has tripled in the past 20 years and is expected to double again in the next 20;
•    The estimated cost of AF is greater than 1 per cent of health care expenditure, and is continuing to rise. The greatest cost is hospitalisation;
•    A post-discharge, AF-specific management program (the SAFETY Intervention) was associated with significantly more days alive and out-of-hospital when compared to standard management.
Funded by the National Health and Medical Research Council of Australia, the study shows more comprehensive research of patients in different states is necessary before governments can comprehensively calculate health, social and economic needs to address this increasingly common condition.  While the benefits for patients cared for outside hospital are obvious, there is medical or community infrastructure to support such care.