Periodic Reporting for period 2 - AFFIRMO (ATRIAL FIBRILLATION INTEGRATED APPROACH IN FRAIL, MULTIMORBID, AND POLYMEDICATED OLDER PEOPLE)
Período documentado: 2022-11-01 hasta 2024-04-30
Worldwide healthcare systems are challenged by the growing number of persons living with multiple (≥2)
chronic conditions (i.e. multimorbidity) and their complex healthcare needs. Current medical practice has traditionally focused on individual diseases, but fails to show effectiveness in the care of patients with multimorbidity, who often receive fragmented, incomplete, and sometimes harmful treatments. The goal of AFFIRMO is to validate the effectiveness of a patient-centred, stratified care pathway for older patients with multimorbidity (including atrial fibrillation as one of the conditions), with the aim of facilitating a multi-disciplinary, shared decision-making process.
chronic conditions (i.e. multimorbidity) and their complex healthcare needs. Current medical practice has traditionally focused on individual diseases, but fails to show effectiveness in the care of patients with multimorbidity, who often receive fragmented, incomplete, and sometimes harmful treatments. The goal of AFFIRMO is to validate the effectiveness of a patient-centred, stratified care pathway for older patients with multimorbidity (including atrial fibrillation as one of the conditions), with the aim of facilitating a multi-disciplinary, shared decision-making process.
The AFFIRMO project develops and validates a patient-centred, stratified care pathway for older patients with multimorbidity, including atrial fibrillation (AF). Significant progress during this reporting period includes identifying seven unique comorbidity patterns in older AF patients from Sweden and Denmark. These patterns have revealed diverse sociodemographic and clinical characteristics, impacting patients' risks for mortality and hospitalisation. These findings have been widely disseminated through manuscripts and presentations at various conferences, emphasising the value of risk stratification based on comorbidity patterns.
The project also assessed drug prescription patterns, focusing on correctness, inappropriate prescriptions, and significant drug-drug interactions using Swedish data. These results were presented at the European Geriatric Medicine Society conference, highlighting the importance of appropriate drug management in multimorbid patients. A new risk stratification tool has been developed using data from Sweden and Denmark. This tool accurately predicts unplanned hospitalisations. It has undergone external validation and categorises patients into four risk levels, proving valuable for prognosis and planning interventions.
The digital framework for personalised care has completed. Study materials and device requirements for the iABC group were finalised, overcoming initial delays in training and ethical approvals. This framework supports shared decision-making and personalised care planning. After overcoming initial delays, the multinational randomized clinical trial has been initiated. Monitoring procedures were developed, and patient randomisation has begun, marking substantial progress.
Further efforts include the development of the Empowerment Toolbox and the AFFIRMO Study APP, which have been successfully developed and translated into the required languages (Danish, Italian, Spanish, Serbian, Romanian, and English). This marks a significant milestone for the AFFIRMO trial. The AFFIRMO Study APP is ready for download from the App Store and Google Play Store.
The groundwork has also been laid for the comprehensive geriatric assessment (CGA) tailored to the AFFIRMO project. The final outputs from related work packages still await the tailored care pathway's implementation. The completion of the digital framework for personalised care have been notable, supporting shared decision-making and personalised care planning.
In conclusion, the AFFIRMO project is progressing steadily, achieving key milestones in identifying multimorbidity clusters, assessing drug prescription patterns, developing risk stratification tools, and initiating the randomized clinical trial to evaluate the effectiveness on clinical and health economic outcomes.
The project also assessed drug prescription patterns, focusing on correctness, inappropriate prescriptions, and significant drug-drug interactions using Swedish data. These results were presented at the European Geriatric Medicine Society conference, highlighting the importance of appropriate drug management in multimorbid patients. A new risk stratification tool has been developed using data from Sweden and Denmark. This tool accurately predicts unplanned hospitalisations. It has undergone external validation and categorises patients into four risk levels, proving valuable for prognosis and planning interventions.
The digital framework for personalised care has completed. Study materials and device requirements for the iABC group were finalised, overcoming initial delays in training and ethical approvals. This framework supports shared decision-making and personalised care planning. After overcoming initial delays, the multinational randomized clinical trial has been initiated. Monitoring procedures were developed, and patient randomisation has begun, marking substantial progress.
Further efforts include the development of the Empowerment Toolbox and the AFFIRMO Study APP, which have been successfully developed and translated into the required languages (Danish, Italian, Spanish, Serbian, Romanian, and English). This marks a significant milestone for the AFFIRMO trial. The AFFIRMO Study APP is ready for download from the App Store and Google Play Store.
The groundwork has also been laid for the comprehensive geriatric assessment (CGA) tailored to the AFFIRMO project. The final outputs from related work packages still await the tailored care pathway's implementation. The completion of the digital framework for personalised care have been notable, supporting shared decision-making and personalised care planning.
In conclusion, the AFFIRMO project is progressing steadily, achieving key milestones in identifying multimorbidity clusters, assessing drug prescription patterns, developing risk stratification tools, and initiating the randomized clinical trial to evaluate the effectiveness on clinical and health economic outcomes.
AFFIRMO continues to be committed on delivering impact on the following dimensions (all in line with the original grant agreement):
Health:
New patient-oriented care pathways for the management of older patients with multimorbidity and polypharmacy are developed and tested. AFFIRMO will develop a comprehensive, multidisciplinary assessment for the management older patients with multimorbidity and AF. The holistic approach will consider both clinical needs and patient preferences. The integrated approach will be implemented and scientifically tested in clinical practice through development of a digital framework.
Scientific:
The evidence provided by the AFFIRMO trial will have the scientific validity to contribute to clinical guidelines at national and international levels. The challenge of ageing populations with increasing levels and complexity of morbidity combined with a paucity of randomized clinical trials on how best to provide efficient and respectful care for these patients will ensure a potential major impact of a successful AFFIRMO trial as it may form basis for subsequent studies on other morbidity clusters.
Training:
Surveys, qualitative interviews and focus groups will allow us to identify needs and key quality performance indicators for use in planning and monitoring the effectiveness of healthcare interventions aimed at improving the management of older patients with multimorbidity. Involvement of healthcare professionals from primary and secondary care across 6 European countries in the AFFIRMO trial will ensure widespread dissemination of knowledge and experience with the AFFIRMO concept. This will facilitate subsequent implementation of this integrated care approach in routine clinical settings.
Social:
The empowerment process implemented in AFFIRMO will likely have an important social impact by providing a better understanding of medical conditions and possible treatment options, whilst improving communication between healthcare professionals and increasing the ability of patients to make informed, shared decisions.
Technological:
The digital platform aims to realize the benefits of the AFFIRMO project by utilizing technology built specifically for older users with co-morbidities. The modular design will enable future development and addition of new features and will be achieved with a strict focus on the protection of patient data. This will enable the platform to be scaled across many different diseases and to support increasing numbers of patients.
Cultural:
AFFIRMO will delineate a new care pathway for the optimal management of older patients with multimorbidity that is trans-sectoral, cost-effective and equitable. The model proposed in the AFFIRMO could be also adopted to a wide spectrum of clusters of chronic diseases not including atrial fibrillation. The active engagement of scientific societies, as well as a patient association combined with the active exploitation and dissemination of the results will foster the cultural background for this approach.
Economic:
The care pathway proposed in the AFFIRMO has the ambition to improve the treatment of patients leading to a reduction in health and societal costs.
AFFIRMO has already produced many good results at this midway point of the project. The progress made and the experiences gathered so far strongly indicate that the project is on track to achieve its projected impact upon completion.
Health:
New patient-oriented care pathways for the management of older patients with multimorbidity and polypharmacy are developed and tested. AFFIRMO will develop a comprehensive, multidisciplinary assessment for the management older patients with multimorbidity and AF. The holistic approach will consider both clinical needs and patient preferences. The integrated approach will be implemented and scientifically tested in clinical practice through development of a digital framework.
Scientific:
The evidence provided by the AFFIRMO trial will have the scientific validity to contribute to clinical guidelines at national and international levels. The challenge of ageing populations with increasing levels and complexity of morbidity combined with a paucity of randomized clinical trials on how best to provide efficient and respectful care for these patients will ensure a potential major impact of a successful AFFIRMO trial as it may form basis for subsequent studies on other morbidity clusters.
Training:
Surveys, qualitative interviews and focus groups will allow us to identify needs and key quality performance indicators for use in planning and monitoring the effectiveness of healthcare interventions aimed at improving the management of older patients with multimorbidity. Involvement of healthcare professionals from primary and secondary care across 6 European countries in the AFFIRMO trial will ensure widespread dissemination of knowledge and experience with the AFFIRMO concept. This will facilitate subsequent implementation of this integrated care approach in routine clinical settings.
Social:
The empowerment process implemented in AFFIRMO will likely have an important social impact by providing a better understanding of medical conditions and possible treatment options, whilst improving communication between healthcare professionals and increasing the ability of patients to make informed, shared decisions.
Technological:
The digital platform aims to realize the benefits of the AFFIRMO project by utilizing technology built specifically for older users with co-morbidities. The modular design will enable future development and addition of new features and will be achieved with a strict focus on the protection of patient data. This will enable the platform to be scaled across many different diseases and to support increasing numbers of patients.
Cultural:
AFFIRMO will delineate a new care pathway for the optimal management of older patients with multimorbidity that is trans-sectoral, cost-effective and equitable. The model proposed in the AFFIRMO could be also adopted to a wide spectrum of clusters of chronic diseases not including atrial fibrillation. The active engagement of scientific societies, as well as a patient association combined with the active exploitation and dissemination of the results will foster the cultural background for this approach.
Economic:
The care pathway proposed in the AFFIRMO has the ambition to improve the treatment of patients leading to a reduction in health and societal costs.
AFFIRMO has already produced many good results at this midway point of the project. The progress made and the experiences gathered so far strongly indicate that the project is on track to achieve its projected impact upon completion.