Community-based analysis of stroke prevention and effect of public interventions in atrial fibrillation: results from the ARENA project.

Maura M Zylla,Belgin Özdemir,Matthias Hochadel,U Zeymer,Ibrahim Akin,Armin Grau,Steffen Schneider,Angelika Alonso,Bernd Waldecker,Tim Süselbeck,Harald Schwacke,Markus Haass,Ralf Zahn,Martin Borggrefe,Jochen Senges,Norbert Frey,Dierk Thomas

doi:10.1007/s00392-024-02510-6

Abstract

Community-based interventions may promote awareness and adherence to atrial fibrillation (AF)-related therapies, potentially reducing adverse events. The ARENA project investigated the health status, therapies and events in AF patients in the Rhein-Neckar Region, Germany. The subproject "ARENA intervention" studied the effect of community-based interventions on AF-associated outcomes. From 2016 onward, patients with diagnosed AF were recruited for the observational ARENA registry. In 2018, an intervention period was initiated involving population-based information campaigns on AF diagnosis and therapies. The "control group" was recruited prior to initiation, and the "intervention group" afterward. Patients underwent standardized follow-up > 1year after recruitment. Clinical outcomes, therapy and quality of life were compared between the two groups. A total of 2769 patients were included. This real-world cohort showed high adherence to oral anticoagulation therapy (OAC) and an increased use of NOACs over vitamin K antagonists over time. In the intervention group (n = 1362), more patients continued OAC at follow-up (87.1% vs. 81.5%, P = 0.002). However, this difference was not significant in the patient subgroup with class I/IIa indications for OAC (90.1% vs. 87.5%, P = 0.11). AF-related re-hospitalization was lower in the intervention group (6.8% vs. 12.3%, P < 0.001). There was no significant difference in quality of life. AF-related anxiety was reduced at follow-up. Of note, nearly a quarter of all patients stated that ARENA had influenced their health perception. Tailored community-based campaigns may raise awareness for AF-related health issues, supporting therapy adherence. Future public strategies to improve quality of life in AF patients should be investigated, as the ARENA project hints at a potential benefit of population-based campaigns. ClinicalTrials.gov (Identifier: NCT02978248).

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