Evidence map›Paper›PMID 32112556›Full record

Trial reportEuropean heart journal2020

Integrated management of atrial fibrillation in primary care: results of the ALL-IN cluster randomized trial.

Carline J van den Dries, Sander van Doorn, Frans H Rutten, Ruud Oudega, Sjef J C M van de Leur, Arif Elvan, Lisa Oude Grave, Henk J G Bilo, Karel G M Moons, Arno W Hoes and 1 more

Open access · bronzeAbstract readRandomized Controlled TrialPragmatic Clinical TrialEquivalence Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European heart journal, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
44citing papers in PubMed, 7 pooled it
6.9field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

44 citing papers in PubMed, 7 syntheses or guidelines pooled it, 74 citations in OpenAlex.

  1. Pooled it
  2. Clinical service organisation for adults with atrial fibrillation.The Cochrane database of systematic reviews · 2024
    Pooled it
  3. Pooled it
  4. Guideline
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  10. Effect of targeted education of patients with atrial fibrillation on unplanned cardiovascular outcomes: results of the multicentre randomized AF-EduCare trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024
    Trial
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  14. Observational
  15. Article
  16. Review
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  19. Global, regional, and national burden of atrial fibrillation and atrial flutter from 1990 to 2021: sex differences and global burden projections to 2046-a systematic analysis of the Global Burden of Disease Study 2021.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025
    Article
  20. Impact of lifestyle risk factors on atrial fibrillation: Mechanisms and prevention approaches - A narrative review.International journal of cardiology. Cardiovascular risk and prevention · 2024
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 3 institutions in 1 country.

Carline J van den DriesJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht/Utrecht University, Str. 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands.
Sander van DoornJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht/Utrecht University, Str. 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands.
Frans H RuttenJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht/Utrecht University, Str. 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands.
Ruud OudegaJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht/Utrecht University, Str. 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands.
Sjef J C M van de LeurThrombosis Service, Isala Hospital Zwolle, Postbus 10400, 8000 GK Zwolle, the Netherlands.
Arif ElvanDepartment of Cardiology, Isala Hospital Zwolle, Postbus 10400, 8000 GK Zwolle, the Netherlands.
Lisa Oude GraveJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht/Utrecht University, Str. 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands.
Henk J G BiloDepartment of Internal Medicine, Isala Hospital Zwolle, Postbus 10400, 8000 GK Zwolle, the Netherlands.
Karel G M MoonsJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht/Utrecht University, Str. 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands.
Arno W HoesJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht/Utrecht University, Str. 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands.
Geert-Jan GeersingJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht/Utrecht University, Str. 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands.
Utrecht University · NLIsala · NLUniversity Medical Center Groningen · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsTo evaluate whether integrated care for atrial fibrillation (AF) can be safely orchestrated in primary care. METHODS AND

resultsThe ALL-IN trial was a cluster randomized, open-label, pragmatic non-inferiority trial performed in primary care practices in the Netherlands. We randomized 26 practices: 15 to the integrated care intervention and 11 to usual care. The integrated care intervention consisted of (i) quarterly AF check-ups by trained nurses in primary care, also focusing on possibly interfering comorbidities, (ii) monitoring of anticoagulation therapy in primary care, and finally (iii) easy-access availability of consultations from cardiologists and anticoagulation clinics. The primary endpoint was all-cause mortality during 2 years of follow-up. In the intervention arm, 527 out of 941 eligible AF patients aged ≥65 years provided informed consent to undergo the intervention. These 527 patients were compared with 713 AF patients in the control arm receiving usual care. Median age was 77 (interquartile range 72-83) years. The all-cause mortality rate was 3.5 per 100 patient-years in the intervention arm vs. 6.7 per 100 patient-years in the control arm [adjusted hazard ratio (HR) 0.55; 95% confidence interval (CI) 0.37-0.82]. For non-cardiovascular mortality, the adjusted HR was 0.47 (95% CI 0.27-0.82). For other adverse events, no statistically significant differences were observed.

conclusionIn this cluster randomized trial, integrated care for elderly AF patients in primary care showed a 45% reduction in all-cause mortality when compared with usual care.

Indexed as

Atrial FibrillationCardiologistsAgedAged, 80 and overAnticoagulantsComorbidityHumansNetherlandsPrimary Health CareAnticoagulantsAnticoagulationAtrial fibrillationIntegrated careMultimorbidityPrimary care

Identifiers

PMID32112556
PMCPMC7421774
OpenAlexW3008885915

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.