CAN GENDER INFLUENCE SYSTEM OF CARE, PATIENT SATISFACTION AND QUALITY OF LIFE FOR PATIENTS REFERRED TO THE ATRIAL FIBRILLATION CLINIC?

Abstract

Few studies have examined gender-related differences in common arrhythmias such as atrial fibrillation (AF) and atrial flutter (AFL). Prior studies indicate that women have a worse quality of life (QOL) and less improvement with treatment compared to men. We examined gender in relation to clinical characteristics and QOL in patients receiving a standardized follow-up program after an Emergency Room (ER) visit with AF/AFL. Consecutive patients presenting to the ER with ECG documented AF or AFL at an urban teaching hospital were treated according to a care protocol, including a patient toolkit at ER discharge and systematic referral to a rapid access AF Clinic. The toolkit included educational pamphlets on AF, stroke and stroke prevention, treatment options, and letters to family doctors. Consenting patients received questionnaires on AF knowledge, satisfaction, and disease specific quality of life (AFEQT - QOL) at first visit and at a three month follow-up. One hundred and twenty eight patients seen in the AF Clinic participated in the AFTER3 study. Fifty nine percent of the patients were male. The mean age was 67.7±13.0 years and 60.8±12.6 for females and males (p=0.0032), respectively. Newly documented AF was reported in 80% of women and 65% of men (p=0.07). Eighty five percent of males and females received a toolkit in the ER. Patients were seen an average of 14.6 days following ER visit, with no difference between men and women. Ninety eight percent of females and 78% males (p=0.0036) brought the toolkit to their AF Clinic appointment. Fifty eight percent of males and 38% of females searched for more information about AF elsewhere (p=0.0473). Over 80% were aware of their diagnosis, while slightly more females (87%) than males (79%) knew that AF increased their risk of stroke. Eight five percent of males and 78% of females were “Very Satisfied” with the care they received in the AF Clinic at 3 month follow-up. Over 90% of males and females indicated that they had a General Practitioner, while only 31% of females and 45% of males had a Cardiologist. Baseline patient characteristics and QOL outcomes are shown in Table 1. In comparison to males, females with AF/AFL were older and had a higher stroke risk. A systematic program of patient education, follow-up and protocol driven care in the AF Clinic led to high patient satisfaction and significant improvement in QOL for both genders.