Arrhythmias & electrophysiologyCohort study
Impact of primary care physician continuity on survival in patients with atrial fibrillation: a retrospective cohort study
- retrospective cohort study
- Cox regression and Fine-Gray competing risk models, adjusted for potential confounders
Authors' conclusion
Longitudinal COC in primary care is associated with improved clinical management, including better OAC indication, and a significant reduction in all-cause mortality among patients with AF. The survival benefit of seeing the same physician appears to extend beyond anticoagulation optimization, highlighting the pleiotropic value of the patient-physician relationship.
Study context
- Population
- Patients with atrial fibrillation (AF) referred by primary care physician (PCPs) between January 2010 and December 2023 in the Santiago de Compostela healthcare area (Spain)all patients with AF referred by PCPs
- Participants
- 17,889 patients
- Exposure
- PCP stability vs interrupted continuity of care (COC)
Main finding
As reported in the abstract
PCP stability
1.5
interrupted COC
1.8
P < 0.001
Observational data: associations, not effects.
Further findings
Adequate OAC indication according to the CHA2DS2-VASc score · higher with PCP stability
P < 0.001
| Outcome | hazard ratio (95% CI) | P value | |
|---|---|---|---|
| All-cause mortality · reduced with COC · benefit remained robust after sensitivity analyses | 0.79 (0.69–0.91) | ||
| 0.512Hazard ratio (log scale) |
Stroke or haemorrhagic complications
- No significant differences
- competing risk analysis suggests that the higher mortality rate in the interrupted COC group likely precluded the observation of non-fatal events
Original publication
Summarised from the published abstract; every number is checked against it