Abstract 369: Symptom Type and Characteristics Differentiate Early from Late Treatment Seekers for Symptoms of Atrial Fibrillation

Abstract

Background: Delay in seeking treatment for symptoms of atrial fibrillation (AF) represents a missed opportunity for early treatment that is critical for reducing serious complications of AF such as stroke and heart failure. Delays ranging from a few days to years after symptom onset have been reported. Little is known about the symptom experiences and cognitive behavioral responses that differentiate those who seek treatment early after symptom onset from those who delay treatment-seeking. Purpose: This study compared symptoms and cognitive behavioral responses of early and late (up to 24 hours versus greater than 24 hours after symptom onset) treatment seekers with symptoms of AF. Methods: A descriptive design was used. Participants (N = 150) were recruited from a Midwest academic medical center. Data regarding 1) type and character of symptoms 2) cognitive and behavioral responses to the symptoms and 3) time from symptom onset to seeking treatment were collected using a structured interview. Independent t-tests for continuous variables and Chi-square tests for categorical variables were used to compare treatment seeking groups. Results: Participants were 51% female, with a mean age of 66.5 SD = 11.1) years. Early treatment seekers (n = 27) were more likely to experience a rapid heartbeat (p <.01), unremitting symptoms (<.001), report fear associated with symptoms (p = .005), and appraise symptoms as very serious (p <.001). They were less likely to believe symptoms could be self-managed (p <.001). Late treatment seekers (n = 123) were more likely to experience fatigue and dyspnea as primary symptoms (p≤ .01), report intermittent symptoms (p <.001), attribute symptoms to stress (p ≤ .02), deconditioning (p <.001), or lack of sleep (p = .009), and take a “wait and see” approach to managing symptoms (p <.001). There were no differences between early and late treatment seekers for age, sex, marital status, education level, and history of coronary artery disease or heart failure. Conclusions: Symptom type and characteristic, and cognitive behavioral responses of early treatment seekers differed from those of late treatment seekers. Experiencing a rapid heartbeat and unremitting symptoms may have helped participants form a cognitive appraisal and behavioral response conducive to early treatment-seeking. Experiencing intermittent symptoms less identifiable with a cardiac origin may have hindered development of cognitive appraisals and behavioral responses that promote early treatment- seeking. Education to promote early treatment-seeking for symptoms should include information about the diverse type and characteristics of symptoms of AF.