Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Nurse-coordinated Integrated Care Model to Support Decision-making and Self-care in Patients With Atrial Fibrillation: A Randomized Controlled Trial
Brief Summary: This study aims to evaluate the effects of a nurse-coordinated, empowerment-based integrated care model on self-care behaviors and psychosocial outcomes in patients with atrial fibrillation (AF), and to explore how this intervention affects the self-care behaviors and quality of life from the patients' perspective.

Stroke prevention by oral anticoagulants (OAC) and control of arrhythmia and risk factors remain the cornerstones of AF management. However, under-prescription, non-adherence to treatment, and suboptimal anticoagulation control limit the efficacy of OACs. The poor abilities of patients regarding the self-control of arrhythmia and risk factors further contributes to worse outcomes. According to the World Health Organization, the best approach to chronic disease management involves the empowerment of patients to become active self-care agents. The literature indicates that a multifaceted, nurse-coordinated care model integrating all important care components with an empowerment approach could most effectively and actively engage patients in self-care.

This mixed-methods study comprises a randomized controlled trial and an exploratory qualitative study. A total of 392 community-dwelling patients aged ≥65 years with a confirmed diagnosis of AF, a high stroke risk, and no OAC treatment will be recruited from the medical outpatient clinics of a university-affiliated teaching hospital. The patients will be randomly allocated to intervention or control groups, which will receive treatment via the nurse-coordinated integrated care model or standard care, respectively. We hypothesize that compared to patients receiving standard care, AF patients exposed to the nurse-coordinated care model will be more likely to achieve compatible patient and physician decisions regarding the use of OAC, as well as better changes in medication adherence, anxiety, depression and health-related quality of life both immediately and 6 months post intervention.

This study will uniquely adopt an empowerment-based approach to equip patients as active agents in AF management through a nurse-coordinated integrated care model that comprehensively addresses their needs. The findings will advance our knowledge of patients' self-care behaviors in the context of AF and will provide a new model of care to improve health outcomes in this population.


Options:
A: Inclusion Criteria:

* age ≥65 years
* community-dwelling
* confirmed diagnosis of AF
* a CHA2DS2-VASc score of ≥1 in men and ≥2 in women
* no use of OAC therapy

Exclusion Criteria:

* impaired communication or cognitive abilities (i.e., an Abbreviated Mental Test score ≤6)
* or severe co-existing medical conditions (e.g., terminal illness) that would hinder participation in research activities
B: Inclusion Criteria:

Veterans with heart failure (HF) treated at the VA Louis Stokes (Cleveland) facilities will be eligible if they have New York Heart Association (NYHA) Class II-III diastolic or systolic HF noted by inpatient or outpatient ICD-9 codes.

Exclusion Criteria:

Veterans treated at the VA Louis Stokes (Cleveland) facilities will be ineligible if they:

* have a serious mental illness or cognitive dysfunction, e.g., psychosis, dementia, or active substance abuse (alcohol and/or other drugs);
* do not speak English fluently;
* are receiving palliative care due to advanced HF or other health problems;
* receive the majority of their HF care from providers outside of the VA;
* are unable to use a telephone to respond to weekly automated self-management support calls; or
* are unable to nominate an eligible informal caregiver.
C: Inclusion Criteria:

* ≥65 years and diagnosed with MI and referred to CR and female or low SEP or single living or non-western background.

Exclusion Criteria:

* Patients unable to provide written consent.
D: Inclusion Criteria:

* Diagnosis of heart failure (stage C chronic HF confirmed by echocardiography and clinical evaluation)
* 19 years of age or greater
* able to speak and read English
* telephone access in home
* Stable pharmacologic therapy per guidelines for past 30 days

Exclusion Criteria:

* clinical evidence of decompensated HF
* unstable angina pectoris
* myocardial infarction, coronary artery bypass surgery, or biventricular pacemaker within the past 6 weeks
* orthopedic or neuromuscular disorders preventing participation in aerobic exercise and strength/resistance training
* participation in 3 times per week aerobic exercise during the past 8 weeks
* cardiopulmonary stress test results that preclude safe exercise training
* plans to move more than 50 miles from the exercise site within the next year
* peak oxygen uptake (pVO2) in women\>21mL kg min and in men \>24mLkg min
* planned or current pregnancy

Answer: A