PO-04-055 ATRIAL FIBRILLATION EDUCATION GONE WRONG: THE INTERSECTION OF PATIENT EDUCATION, ANXIETY, AND AMBIGUITY IN AN ATRIAL FIBRILLATION PATIENT

Abstract

Atrial fibrillation (AF) patients have significant symptom burden resulting in uncertainty and distress. Patients often seek out medical information from their healthcare team, online resources, and significant others to better understand their experience and diagnosis. We report a case of an AF patient referred for an ablation complicated by influx of information across settings and iatrogenic anxiety. Patient presented to the Cardiac Psychology Service with poor understanding, high anxiety, and uncertainty that led to paralysis of the recovery process. A 60-year-old White married female with medical history of AF, hypertension, diabetes, hyperlipidemia, PVCs, and former smoker presented for distress related to her AF diagnosis. Prior visits with a cardiologist triggered questions about her condition, anti-coagulation use, possible loop recorder insertion, LAAO devices, and long-term prognosis. Interactions with her healthcare team led to increased anxiety, hypervigilance of symptoms, uncertainty of medical decisions, and fears about AF recurrence and progression. This prompted online investigation of her treatment options, frequent healthcare utilization, and internet inquires for “Dr. Google” resulting in decision to postpone the ablation. The patient was treated by cardiac psychology to help restore a sense of control, reinforce shared-decision making and understanding. Focuses included disentangling alarming medical information from medical advice and existence of multiple treatment options. Given this was her first significant health concern and the episodic nature of AF, ambiguity and associated fears were normalized to further increase confidence navigating information presented. Behavioral changes and a self-management model were emphasized to promote less vigilance adversity and more attention to both appropriate psychological and physical health concerns. Psychological treatment combined with education from her EP addressed the lack of comprehensive medical information which led to improved adherence, decreased anxiety, and pursuit of recommended ablation. The present case highlights the potential implications of uncertainty and overabundance of information on AF treatment. Early recognition of anxiety by the EP physician should prompt a referral to a cardiac psychologist for comprehensive multidisciplinary care to minimize impact of misinformation on patient experience.