Outpatient monitoring of patients with atrial fibrillation: current trends in improving efficiency

This article summarizes Russian and international experience in improving the effectiveness of outpatient monitoring for patients with atrial fibrillation (AF). AF is one of the most common arrhythmias, diagnosed in approximately 2-3% of the adult population. AF prevalence rises with the increasing proportion of older people in the population. Without anticoagulant therapy, left atrial appendage thrombi develop in a significant proportion of patients, increasing the risk of stroke, heart failure, and death. In Russia, outpatient monitoring is regulated by standards and clinical guidelines, but only about half of patients are regularly monitored. Indicators of hospitalizations, disability, mortality, and adherence to therapy are rarely included in the reporting, making it difficult to assess outpatient monitoring effectiveness. The need for a unified methodology for outpatient management of patients with AF, including validated questionnaires, digital remote monitoring platforms, and the use of health information systems, is emphasized. The need for a multicenter Russian study aimed at developing and implementing managing and methodological approaches to improve the effectiveness of remote monitoring for patients with AF is identified.

1. Bryanceva OV. Arrhythmic syndrome as a clinical manifestation of premature aging processes. Fundamental research. 2012;2:263-6. (In Russ.)

2. Arakelyan MG, Bokeriya LA, Vasilyeva EYu, et al. Atrial fibrillation and flutter. Clinical guidelines 2020. Russian Journal of Cardiology. 2021;26(7):4594. (In Russ.) doi:10.15829/1560-4071-2021-4594.

3. Zotov AS, Sakharov ER, Korolyov SV, et al. Atrial fibrillation in patients with ischemic heart disease: Current state of the problem. Klinicheskaya praktika. 2021;12(4):66-74. (In Russ.) doi:10.17816/clinpract84464.

4. Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics –2020 update: A report from the American Heart Association. Circulation. 2020;141(9):e139-e596. doi:10.1161/CIR.0000000000000757.

5. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42(5):373-498. doi:10.1093/eurheartj/ehaa612.

6. Drapkina OM, Boytsov SA, Golukhova EZ, et al. Outpatient follow-up of patients with atrial fibrillation and flutter by a primary care physician. Guidelines. Primary Health Care (Russian Federation). 2024;1(1):134-78. (In Russ.) EDN IXJDOK.

7. Peinado R, Arribas F, Ormaetxe JM, et al. Variation in quality of life with type of atrial fibrillation. Rev Esp Cardiol. 2010;63(12):1402–9. English, Spanish. doi:10.1016/s1885-5857(10)70274-7.

8. Steinberg BA, Kim S, Fonarow GC, et al. Drivers of hospitalization for patients with atrial fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Am Heart J. 2014;167(5):735-42. doi:10.1016/j.ahj.2014.02.003.

9. Benjamin EJ, Muntner P, Alonso A, et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56-528. doi:10.1161/CIR.0000000000000659.

10. Miyasaka Y, Barnes ME, Gersh BJ, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114(2):119-25. doi:10.1161/CIRCULATIONAHA.105.595140.

11. Heeringa J, van der Kuip DA, Hofman A, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J. 2006;27(8):949-53. doi:10.1093/eurheartj/ehi825.

12. Naccarelli GV, Varker H, Lin J, et al. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol. 2009;104(11):1534-9. doi:10.1016/j.amjcard.2009.07.022.

13. Stewart S, Hart CL, Hole DJ, et al. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study. Heart. 2001;86(5):516-21. doi:10.1136/heart.86.5.516.

14. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370-5. doi:10.1001/jama.285.18.2370.

15. Revishvili ASh, Shlyakhto EV, Sulimov VA, et al. Atrial fibrillation: Clinical guidelines. Journal of Arrhythmology. 2017;4:468-70. (In Russ.)

16. Mardanov BU, Korneeva MN, Akhmedova EB. Analysis of the latest international clinical studies on atrial fibrillation: trends and prospects. International Journal of Heart and Vascular Diseases. 2015;3(8):11-6. (In Russ.)

17. Oganov RG, Salimov VA, Bokeria LA, et al. Clinical guidelines for the diagnosis and treatment of patients with atrial fibrillation. Journal of Arrhythmology. 2010;59: 53- 77. (In Russ.)

18. Sychev OS. Atrial fibrillation. Modern approaches to the treatment and prevention of complications in patients with concomitant heart pathology. Ukrainian Medical Journal. 2011;10-12:54-8. (In Russ.)

19. Vertkin AL, Prokhorovich EA, Skotnikov AS, et al. Patient with atrial fibrillation at the outpatient appointment with a therapist. The Russian Archives of Internal Medicine. 2013;(3):25-37. (In Russ) doi:10.20514/2226-6704-2013-0-3-25-37.

20. Kuchina AYu, Novikova NA, Suvorov AYu, et al. Characteristics of elderly and senile patients with atrial fibrillation in clinical practice. Russian Journal of Cardiology and Cardiovascular Surgery. 2019;12(3):213-21. (In Russ.) doi:10.17116/kardio201912031213.

21. Bazhenov ND, Mazur VV, Mazur ES. Thrombosis of the left atrial appendage. Verkhnevolzhskiy meditsinskiy zhurnal. 2021;20(3):3-13. (In Russ.)

22. Banerjee A, Benedetto V, Gichuru P, et al. Adherence and persistence to direct oral anticoagulants in atrial fibrillation: A population-based study. Heart. 2020; 106(2):119-26. doi:10.1136/heartjnl-2019-315307.

23. Ganeeva ON. Left atrial appendage occlusion in atrial fibrillation. Circulation patology and cardiac surgery. 2014;4:104-12. (In Russ.). doi:10.21688/1681-3472-2014-4-104-112.

24. Krivosheev YuS, Bashta DI, Krasilnikova SYu, et al. Thrombosis of the left atrial appendage in atrial fibrillation: Current state of the problem. Journal of Arrhythmology. 2019;26(4):13-20. (In Russ.) doi:10.35336/VA-2019-4-13-20.

25. Boytsov SA, Kalinina AM, Ipatov PV. Dispensary observation of the adult population as a mechanism for identifying cardiovascular diseases and forming dispensary observation. Vestnik Roszdravnadzora. 2015;5:11-8. (In Russ.)

26. Voshev DV, Vosheva NA, Son IM, et al. Medical information systems as an integral element of the infrastructural readiness of primary healthcare organizations for digital transformation. Problemy standartizatsii v zdravookhranenii. 2023;9-10:71-9. (In Russ.) doi:10.26347/1607-2502202309-10071-079.

27. Nazarov AM, Tolpygina SN, Bolodurina IP. Analysis and evaluation of the results of medical care for patients with ischemic heart disease. Cardiovascular Therapy and Prevention. 2020;19(6):18-23. (In Russ.) doi:10.15829/1728-8800-2020-2665.

28. Zelionko AV, Luchkevich VS, Filatov VN, et al. Formation of population risk groups based on the level of hygienic awareness and motivation for health-preserving behavior. Gigiena i sanitariya. 2017;96(4):441-86. (In Russ.) doi:10.18821/0016-9900-2017-96-4-486-441.

29. Sandakov YaP, Kochubey AV. Compliance of patients under dispensary observation. Problems of social hygiene, public health and history of medicine. 2019;27(2):135- 40. (In Russ.) doi:10.32687/0869-866X-2019-27-2-135-138.

30. Lukina YuV, Kutishenko NP, Martsevich SYu, et al. Development and validation of new questionnaires in medicine using the example of the medication adherence scale. Rational Pharmacotherapy in Cardiology. 2020;17(4):576-83. (In Russ.) doi:10.20996/1819-6446-2021-08-02.

31. Amir M, Feroz Z, Beg AE. A new health care professional-based model for medication adherence. Patient Prefer Adherence. 2018;12:2085-91. doi:10.2147/PPA.S171989.

32. Souza AC, Borges JW, Moreira TM. Quality of life and treatment adherence in hypertensive patients: Systematic review with meta-analysis. Rev Saude Publica. 2016;50:71. doi:10.1590/S1518-8787.2016050006415.

33. Yoon M, Lee JH, Kim IC, et al. Smartphone app for improving self-awareness of adherence to edoxaban treatment in patients with atrial fibrillation (ADHEREApp Trial): Randomized controlled trial. J Med Internet Res. 2024;26:e65010. doi:10.2196/65010.

34. Guo Y, Corica B, Romiti GF, et al. Efficacy of mobile health-technology integrated care based on the "Atrial fibrillation Better Care" (ABC) pathway in relation to sex: A report from the mAFA-II randomized clinical trial. Intern Emerg Med. 2023;18(2): 449-56. doi:10.1007/s11739-022-03188-2.

35. Dahlberg M, Jakobsson U. Nurse-led atrial fibrillation clinics in primary health care: A review of the evidence. Scand J Prim Health Care. 2025;43(1):1-5. doi:10.1080/02813432.2025.2466175.

36. Efanov AYu, Kremneva LV, Safiullina ZM, et al. Role of modern technologies in dispensary observation of patients with arterial hypertension in the Tyumen region included in the register of patients with chronic non-communicable diseases. Cardiovascular Therapy and Prevention. 2017;16(5):46-51. (In Russ.) doi:10.15829/1728-8800-2017-5-46-51.

37. Lukyanov MM, Yakushin SS, Martsevich SYu, et al. Cardiovascular diseases and their drug treatment in patients with acute cerebrovascular accident: Data from the outpatient registry REGION HEART based on electronic services. Cardiovascular Therapy and Prevention. 2019;18(6):30-6. (In Russ.) doi:10.15829/1728-8800-2019-6-30-36.

38. Korennova OYu, Druk IV, Podolnaya SP, et al. Effectiveness of dispensary observation of patients with very high cardiovascular risk in the Omsk region. Bulletin of Rehabilitation Medicine. 2022;21(3):121-8. (In Russ.) doi:10.38025/2078-1962-2022-21-3-9-23.

39. Guo Y, Lane DA, Chen Y, et al. Regular bleeding risk assessment associated with reduction in bleeding outcomes: The mAFA-II randomized trial. Am J Med. 2020; 133(10):1195-202.e2. doi:10.1016/j.amjmed.2020.03.019.

40. Gawałko M, Duncker D, Manninger M, et al. The European TeleCheck-AF project on remote app-based management of atrial fibrillation during the COVID-19 pandemic: Centre and patient experiences. Europace. 2021;23(7):1003-15. doi:10.1093/europace/euab050.

41. Dinesen B, Albertsen AE, Joensen EDR, et al. Future Patient-Telerehabilitation of Patients With Atrial Fibrillation: Protocol for a Multicenter, Mixed Methods, Randomized Controlled Trial. JMIR Res Protoc. 2025;14:e64259. doi:10.2196/64259.

42. Nadarajah R, Wahab A, Reynolds C, et al. Future innovations in novel detection for atrial fibrillation (FIND-AF): Pilot study of an electronic health record machine learning algorithm-guided intervention to identify undiagnosed atrial fibrillation. Open Heart. 2023;10(2):e002447. doi:10.1136/openhrt-2023-002447.