Management of modifiable risk factors and comorbidities in atrial fibrillation: suggestions for improvement from a patient perspective

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): SLL Region Stockholm Innovation SLL Region Stockholm Klinisk Forskare. Background In patients with atrial fibrillation (AF), improved management of modifiable risk factors, unhealthy lifestyle and concomitant diseases is highly recommended by guidelines, in particular if rhythm control is desired. Yet, many AF patients have suboptimal management of risk factors and comorbidities. There is a lack of understanding how patients can be better aided to achieve these goals in clinical practice. Digital health solutions may offer support in this matter. Purpose To identify what patients with atrial fibrillation would find important in a digital tool aimed at optimization of modifiable risk factors and comorbidities. Methods This is a qualitative, descriptive study based on semi-structured interviews that were analyzed by manifest content analysis. 16 AF patients with recent in- or outpatient encounters were included (age 68 (52-78) years; 43% female; BMI 29.5 (20.4-35.8) kg/m2; paroxysmal/persistent AF (50%/50%); AF duration 7 (0-22) years). Four semi-structured focus-group interviews were conducted. Study results were intended to inform the development of a digital tool aimed to support risk factor and comorbidity optimization in patients scheduled for rhythm control interventions. Results Relevant comorbidities were hypertension (88%), heart failure (25%), diabetes mellitus type 2 (19%) and ischemic heart disease (13%). Only 19% stated that they were satisfied with their current level of physical activity and 19% were satisfied with their current eating habits. The participants’ suggestions were summarized into three main categories. First, person-centered information is essential, meaning that information should be customized, conveyed in an appropriate tone and include practical tips. Second, there is an unmet need for help with managing lifestyle habits in a way that is easily applicable in everyday life, and patients desire help with creating habits. Third, regular communication is necessary including inspirational reminders and motivational feedback. Conclusions From a patient perspective, person-centered information, practical help with managing lifestyle habits, and regular communication are considered essential in helping to optimize treatment of comorbidities and associates risk factors associated to lifestyle. This can, at least in part, be done digitally and should be implemented more in standard care to improve outcomes and reduce cost.