Atrial fibrillation integrated approach in frail, multimorbid, and polymedicated older people
Multimorbidity is a common condition in older age, and can substantially influence individuals’ health and quality of life, making management more difficult. A single-disease approach with fragmented care is still prevalent in current healthcare systems despite multimorbidity representing a heterogeneous spectrum of disease combination(s). On this background, the novel approach underpinning the AFFIRMO project is to focus on clusters of multimorbidity where atrial fibrillation(AF) represents one of the chronic conditions. Improving the management of AF in the context of multimorbidity may benefit individuals on a larger scale, with a holistic approach to optimize clinical management of older AF patients taking into account the multifaceted aspects of individuals’ health, including multimorbidity, polypharmacy, personal preferences, and social context. 
First, the project aims to identify different clusters of multimorbidity in older patients with AF. Second, AFFIRMO aims to assess the needs of patients, caregivers, and health professionals for the comprehensive management of multimorbidity including AF, and to examine ways of optimizing care and self-management. Third, AFFIRMO will develop, implement and test the effectiveness of a patient-centered approach on older multimorbid AF patients in the clinical practice. We aim to adapt, implement and promote a care pathway, in older patients with multimorbidity. A specific objective will be to develop an interoperable care framework that can facilitate the application of this personalized care pathway, that bridges the continuum between primary and secondary care, with the active involvement of patients with shared decision-making. A further aim will be to model the impact of multimorbidity including AF on healthcare costs and the health economic benefits by the proposed integrated care pathway. Finally, subgroup analyses would assess differences on outcomes of in relation to gender and social inequalities.