Discussion
stroke, fractures
STROKE, EVENTS, MYOCARDIAL INFARCTION, CARDIAC DECOMPENSATION
The management of patients with AF, HF or TRH by NICC combining telemedicine with intensive round-the-clock support by a core care centre was not superior over the management of patients using SoC. The lack of benefit was mainly driven by the fact that the number of inpatient days did not differ between the groups. Despite a significant reduction in combined endpoints of (cardiovascular) mortality, stroke, myocardial infarction and cardiac decompensation, the predefined statistical analysis plan dictated a significant test for the number of inpatient days as a prerequisite for superiority of NICC over SoC.Unlike other studies using controlled designs, we did not record the reasons for hospitalisation, and thus, hospitalization may have been caused by acute events unrelated to cardiovascular conditions (e.g., fractures). Another perspective is that the integrated care concept results in intensified follow-up and may have resulted in early hospitalization in case of slightest doubt about patient safety and well-being. In fact, this preventive and cautious management of patients may have been the sole reason for the highly significant reduction in clinical endpoints without a reduction in the number of inpatients days. Others have also reported similar results for patients with AF using an integrated care concept compared to usual care [