Knowledge Of Atrial Fibrillation Research Articles

A nurse-led intervention improves quality of life and reduces arrhythmic recurrences in patients undergoing atrial fibrillation ablation. Results of the NURSECAT-AF randomized clinical trial

Abstract Background/Introduction Atrial fibrillation (AF) is a prevalent condition that can lead to a decrease in quality of life and frequent re-hospitalizations. Some data suggest that integrated care nurse-led may blunt these consequences in unselected patients with AF, but not all studies support this. While AF ablation is becoming a cornerstone treatment for symptomatic patients with AF, it is unclear what impact a nurse-led intervention would have on these, quite likely, more receptive patients. Purpose To assess the impact of nurse-led intervention on quality of life among AF patients undergoing ablation. Methods We conducted a single-centre prospective randomised clinical trial to test the effect of an expert nurse-based intervention consisting of an educational programme on AF, support for the patient undergoing cardiac ablation to ensure its success, and management of risk factors associated with this arrhythmia. The control group underwent standard medical follow-up. Patient selection was based on chronological order. Only patients who underwent their first ablation and did not have heart failure were included. The primary endpoint was quality of life at 12 months post-ablation using the Arrhythmia-Specific Scale in Tachycardia and Arrhythmia (ASTA) questionnaire (higher values denote impaired quality of life). Secondary endpoints were AF knowledge and satisfaction at 15 days post-ablation using validated instruments, symptoms using the ASTA questionnaire as well, and readmissions rates, emergency room visits, and AF recurrence rates over a one-year period. Results 116 patients were screened (50 were excluded mostly because were re do). A total of 66 patients were eventually included and randomized (33 per arm; mean age [mean±SD] 63±10 years; 44 men [67%]). At 12 months, quality of life was significantly better in the intervention group than in the control group (4.5 ± 6.1 vs 0.57 ± 2.3, respectively, p=0.001)(Figure). Furthermore, satisfaction levels (17 ± 4.1 vs 12.7 ± 5.4, p>0.001) and disease knowledge (20.5 ± 5.1 vs 15.9 ± 4.5, p<0.001) were higher in the intervention group. Patients in the control group experienced a higher symptom burden during the first year (0.6 ± 1.5 vs 3.8 ± 4.5, p<0.001. Relevant clinical endpoints such as readmissions (3% vs 18.2%, p=0.046), emergency room visits (21.2% vs 57.5%, p=0.021), and arrhythmia recurrences (15.2% vs 45.5%, p=0.02) were all significantly lower in the intervention group. Conclusion(s) Nurse-led integrated care for patients undergoing AF ablation yields substantial improvements in quality of life and symptomatic relief at one year post-procedure. Additionally, it enhances patient knowledge of AF and satisfaction levels, and reduces readmissions, emergency room visits, and arrhythmia recurrences.

Factors influencing patient engagement in decision making for catheter ablation of atrial fibrillation: a cross-sectional survey.

Patient engagement in decision making could improve healthcare quality and health outcome, which has been emphasized in atrial fibrillation (AF) management guidelines. However, patients report relatively low level of engagement in decision making for catheter ablation (CA). Therefore, this study aims to explore the influencing factors of AF patient engagement in decision making for CA. A cross-sectional study was conducted. A total of 836 patients were recruited from six tertiary hospitals in Shanghai. Adapted version of the Control Preferences Scale, Chinese version of the All Aspects of Health Literacy Scale, Chinese version of the Facilitation of Patient Involvement Scale and the Atrial Fibrillation Knowledge Questionnaire were used to measure patient engagement in decision making, health literacy, perception of physician facilitation and AF knowledge, respectively. Of the 750 patients who returned valid questionnaires, 20.2% of the patients reported active engagement in decision making, 39.5% reported collaborative engagement, and 40.3% reported passive engagement. Compared with patients perceiving passive engagement, those with collaborative or active engagement were more likely to be female, have higher income, moderate EHRA class (II and III), higher perception of physician facilitation, higher health literacy and higher AF knowledge (P＜0.05 for all). The collaborative engagement group exhibited a shorter AF duration. The degree of patient engagement in CA decision making varied, with most perceiving passive engagement. Patient engagement in decision making was influenced by gender, income, duration of AF, EHRA class, perception of physician facilitation, health literacy and AF knowledge.

Does coping style mediate the relationship between knowledge and psychosocial outcomes in women with atrial fibrillation?

In patients affected by atrial fibrillation (AF) disease-specific knowledge and coping style may be associated with psychosocial well-being. This study aimed to determine if coping style (problem-focused, emotion-focused, avoidance-focused) mediated the relationship between patient knowledge and three psychosocial outcomes (anxiety, depression and life satisfaction). In 2021a total of 188 women with reported AF, and ages ranging from 18 to 83 years (mean 48.7, sd 15.5 years), completed an online questionnaire consisting of sociodemographic, clinical and AF knowledge questions and psychosocial instruments (Anxiety and depression, the Hospital Anxiety and Depression (HADS) scale; life satisfaction, Satisfaction With Life Scale (SWLS); and coping style (Brief COPE). Using Jamovi statistical software three individual mediational models (for anxiety, depression and life satisfaction) were constructed assessing the direct and indirect relationships between knowledge, coping style and each psychosocial outcome. Age was a covariate in each model. The mediation analyses demonstrated significant direct negative associations between AF knowledge and HADS anxiety and depression and positive associations with SWLS. There were also direct associations between each of the three coping styles and the three psychosocial outcomes. There were significant indirect effects of coping style between AF knowledge and each of the three outcomes confirming partial mediation effects. These findings highlight the crucial role of coping style in mediating the association between AF knowledge and psychosocial outcomes. As such, interventions aimed at increasing patient knowledge of AF may be more effective if adaptive problem-solving coping strategies are also demonstrated to these patients. Additionally, modification of maladaptive coping strategies as part of the psychological management of patients with AF is highly recommended.

Variation and disparity in awareness of atrial fibrillation in China: A national cross-sectional study

BackgroundThe latest information regarding the awareness of atrial fibrillation (AF) remains limited in China. ObjectivesThe present study aimed to understand the variation and disparity in awareness of AF in China. MethodsThe cross-sectional study used data from the 2020 nationwide epidemiology survey on AF among adults aged 18 years or older in mainland China to assess the prevalence of AF awareness. The awareness of AF diagnostic methods and outcomes was also assessed using an interviewer-administered questionnaire. ResultsOf the 114,039 adults responding to the survey, 1463 (age-standardized prevalence, 55.3% (95% confidence interval [CI], 47.7–62.9%) and 10,202 (8.2%, 95%CI 5.4–10.9%) were aware of AF in participants with and without AF, respectively. Of these, 36.4% (95%CI 30.0–42.9%) and 6.3% (95%CI 3.6–9.1%) considered electrocardiogram as a method of diagnosing AF, and 30.0% (95% CI 3.2–8.2%) and 5.2% (95%CI 2.7–7.6%) considered stroke as an outcome of AF. The proportion of participants who being aware of AF varied significantly across sociodemographic and cardiovascular disease subgroups, and was almost consistently lower in rural areas than those in urban areas. Overall, lack of AF awareness was associated with rural areas, geographical region, lower education levels, and without history and had no risk factors of cardiovascular disease. ConclusionsNearly half of adults with AF, and >90% non-AF population are unaware of AF in China, with significant variation and disparity. Focused public health initiatives are needed to improve awareness and knowledge of AF among high-risk populations.

Clinician-Created Video Education for Patients With AF

Patient education is a critical aspect of atrial fibrillation (AF) management. However, there is limited time to provide effective patient education during routine care, and resources available online are of variable quality. To determine whether clinician-led creation of video-based AF education is feasible and improves knowledge of AF. This single-center randomized clinical trial was conducted between 2020 and 2022. Outcomes were assessed prior to their clinic visit and 2 and 90 days after the visit by blinded assessors. Participants included adults with AF and congestive heart failure, hypertension, age at least 75 years (doubled), diabetes, prior stroke or transient ischemic attack or thromboembolism (doubled), vascular disease, age 65 to 74 years, and sex category scores of 1 or greater presenting for routine care at publicly funded outpatient cardiology clinics within a tertiary teaching hospital. Individuals too unwell to participate or with limited English were excluded. Data were assessed as intention to treat and analyzed from December 2022 to October 2023. Intervention participants viewed a series of 4 videos designed and narrated by clinicians that aimed to improve understanding of AF pathophysiology, clinical presentation, diagnosis, and management. After viewing the videos, participants received weekly email links to review the videos. The control group received usual care. The prospectively selected primary outcome was AF knowledge at 90 days, measured by the validated Jessa Atrial Fibrillation Knowledge Questionnaire (JAFKQ). Among 657 individuals screened, 208 adults with AF were randomized (mean [SD] age, 65.0 [12.2] years; 133 [65.2%] male) and included in analysis. Participants were randomized 1-to-1, with 104 participants in the control group and 104 participants in the video intervention group. At 90 days after the baseline clinic visit, intervention participants were more likely to correctly answer JAFKQ questions than control participants (odds ratio [OR], 1.23 [95% CI, 1.01-1.49]). The difference was greater in participants who remotely accessed videos on 3 or more occasions during the study (OR, 1.46 [95% CI, 1.14-1.88]). In this randomized clinical trial of patients with AF, remotely delivered, clinician-created video education improved medium-term AF knowledge beyond usual care of standard in-clinic education. The improvement demonstrated in this study provides support for the implementation of clinician-created educational resources across the care continuum. Further work is needed to assess for impact on clinical outcomes. anzctr.org.au Identifier: ANZCTRN12620000729921.

Clinician-created video education for patients with atrial fibrillation: a randomised clinical trial

Abstract Background Improved health literacy is associated with better health outcomes.(1) Atrial fibrillation (AF) is a complex condition and patient understanding of AF is poor.(2) There is little time during routine care to provide education on AF. Clinic waiting time provides an opportunity to deliver education that improves AF knowledge and engagement with clinical care. Purpose Assess the efficacy and feasibility of remotely-delivered clinician-created education for patients with AF. Methods Single-centre randomised clinical trial (ANZCTRN 12620000729921, registered 13/07/2020) conducted in adults over 18 years of age awaiting outpatient cardiac clinic appointments with electrocardiogram-confirmed AF, CHA²DS²VASc > 0 and an active electronic mailing address or mobile phone. Those with insufficient English proficiency to comprehend video content were excluded. Eligible participants were recruited remotely and randomised 1:1 to an internet-based intervention of 4 animated videos narrated by treating cardiologists totalling 15 minutes with the option to review videos weekly, or usual care. Recruiting staff, outcome assessors and those responsible for statistical analysis were blinded to treatment allocation. The primary outcome was Jessa AF Knowledge Questionnaire (JAKQ) score (a 16-item validated questionnaire consisting of general AF and anticoagulation-specific questions(2)) at 90 days post recruitment adjusted for baseline performance, AF diagnosis, educational level, age and sex. A sample size of 200, allowing for 15% attrition and a standard deviation of 18 described previously(2) was prospectively calculated to have 90% power (2-sided, type 1 error of 5%) to detect an 8.95% difference in 90-day AF knowledge. Results Between November 2020 and July 2022, 208 patients were randomised (104 intervention, 104 control). Mean (standard deviation) age was 65.0 (12) years, and 65.2% were male. Most (56.2%) had paroxysmal AF and 6.4% had first episode AF. Intervention participants were more likely to correctly answer JAKQ questions at 90 days (odds ratio [OR] 1.23 [95% confidence interval (CI) 1.01, 1.49]). Highly engaged participants were more likely to have higher JAKQ scores (OR 1.46 [95% CI 1.14, 1.88] among those who watched videos on 3 or more weeks compared to control). Video satisfaction was high (figure 2). There was no significant difference in satisfaction with care or education provided in clinic OR 1.32 [95% CI 0.71, 2.44]). Conclusions A clinician-created, low-cost, remotely-delivered educational intervention among patients with AF awaiting cardiac clinic appointments was highly acceptable and improved AF knowledge at 90 days. Increased intervention exposure correlated with higher knowledge scores. Future delivery of this intervention could investigate impact on medication adherence, AF burden, and patient-reported quality of life outcomes.Figure 1Figure 2

Knowledge and unmet needs of patients with atrial fibrillation in China: a nationwide cross-sectional survey

Abstract Background Knowledge about the disease and treatment options is necessary for active patient engagement in shared decision-making, which is essential for ’patient-centered’ atrial fibrillation (AF) management. Purpose To evaluate the knowledge level and identify unmet needs of patients with AF in China. Methods A nationwide cross-sectional survey was conducted using online or paper questionnaires between May and August 2022. Adult AF outpatients or inpatients in China were eligible for participation. The questionnaires included items on knowledge regarding AF, treatment options, risk factors, AF treatment practice, and AF patients’ unmet needs. Results This survey included 2,002 patients with AF [mean age 68.62±13.45, 1,040 (52%) men] from 55 centers across 17 provinces in China. Most patients (66.18%) had knowledge scores of < 4 (an 8-item disease knowledge scale, the score ranged from 0 [worst] to 8 [best]), which is a poor knowledge level. Approximately half of the patients did not know that "AF can cause blood clots which can lead to stroke (cerebral infarction)." The proportion of patients who knew about oral anticoagulants, cardiac rhythm/heart rate control drugs, and catheter ablation were 85.96%, 81.37%, and 41.36%, respectively. However, only 79.52%, 72.08%, and 16.18% of patients received these respective treatments. Moreover, only 51.46% of patients were satisfied or very satisfied with their treatments. The improvement in life quality, prevention and treatment of complications, and symptom control were the three most important aspects for patients when choosing treatments. The impact of AF on daily activities, sleep, emotions, and memory were reported by 80.77%, 63.54%, 52.80%, and 66.18% patients, respectively. Most patients with AF recognized hypertension (87.50%) and diabetes mellitus (50.33%) as risk factors, but few recognized obesity and excessive alcohol intake. Overall, 93.56% of patients obtained AF knowledge from physicians. They expect the source of knowledge to include regular community education(61.29%), as well as digital tools(58.74%) between physicians and patients. Furthermore, 90.86% of patients considered involvement in treatment decisions necessary. Conclusions This study reveals that the knowledge level of patients with AF in China regarding the disease and treatment options is insufficient, and there remain unmet needs for AF management. Thus, more patient-centered education through multiple channels is required to improve patients' involvement in treatment decisions.

Quality of life among patients with atrial fibrillation: A theoretically-guided cross-sectional study.

Patients with atrial fibrillation (AF) have significantly lower health-related quality of life (HRQoL) compared to the general population and patients with other heart diseases. The research emphasis on the influence of AF symptoms on HRQoL overshadows the role of individual characteristics. To address this gap, this study's purpose was to test an incremental predictive model for AF-related HRQoL following an adapted HRQoL conceptual model that incorporates both symptoms and individual characteristics. Patients attending an AF specialty clinic were invited to complete an online survey. Hierarchical regression analyses were conducted to examine whether individual characteristics (overall mental health, perceived stress, sex, age, AF knowledge, household and recreational physical activity) incremented prediction of HRQoL and AF treatment satisfaction beyond AF symptom recency and overall health. Of 196 participants (mean age 65.3 years), 63% were male and 90% were Caucasian. Most reported 'excellent' or 'good' overall and mental health, had high overall AF knowledge scores, had low perceived stress scores, and had high household and recreation physical activity. The mean overall AF Effect On Quality-Of-Life Questionnaire (AFEQT) and AF treatment satisfaction scores were 70.62 and 73.84, respectively. Recency of AF symptoms and overall health accounted for 29.6% of the variance in overall HRQoL and 20.2% of the variance in AF treatment satisfaction. Individual characteristics explained an additional 13.6% of the variance in overall HRQoL and 7.6% of the variance in AF treatment satisfaction. Perceived stress and household physical activity were the largest contributors to overall HRQoL, whereas age and AF knowledge made significant contributions to AF treatment satisfaction. Along with AF symptoms and overall health, individual characteristics are important predictors of HRQoL and AF treatment satisfaction in AF patients. In particular, perceived stress and household physical activity could further be targeted as potential areas to improve HRQoL.

Disease-Related Knowledge and Need for Revision of Care for Patients with Atrial Fibrillation: A Cross Sectional Study.

To evaluate the disease-related knowledge of outpatients with atrial fibrillation (AF), and the relationship with health literacy and other background variables. In this cross-sectional survey study, conducted in Iceland, patients with AF scheduled for an electrical cardioversion or AF catheter ablation were recruited from a hospital outpatient clinic. They completed the validated Atrial Fibrillation Knowledge Scale (AFKS), a 11-item instrument (with possible score 0-10, 10 being the best knowledge) which evaluates knowledge pertaining to AF in general, AF symptom detection and AF treatment. Health literacy was assessed with the 16 item European Health Literacy Survey Questionnaire (HLS-EU-Q) and patients answered questions about their background. Data was analysed with parametric tests. In total, 185 participants completed the questionnaire (mean age 63 ±10), 77% were male, 74% with previous electrical cardioversion and 76% were on non-vitamin K antagonist oral anticoagulants (NOAC) medication. The mean score on the AFKS was 6.5 (±1.8). The best knowledge was concerning oral anticoagulation therapy (96% answered correctly) and the least knowledge was regarding responses to AF episodes (17% answered correctly). Patients with sufficient health literacy (52%) had better knowledge of AF (M 6.8 ±1.7 vs M 6.3 ±1.9, p = 0.05). Age, educational level, health literacy and AF pattern explained 22% of the variance in AF knowledge. Patients with AF have inadequate knowledge of their condition, potentially as a result of insufficient health literacy. AF knowledge may be improved using integrated management where patients are actively involved in the care and health literacy is considered in the provided patient education.

Engagement of atrial fibrillation patients with the AF-EduApp, a new mobile application to support AF management.

A multidisciplinary approach is needed for the management of atrial fibrillation (AF) in which the patient has a central role. Smart devices create opportunities to improve AF management. This paper aimed to evaluate the in-house developed AF-EduApp application on its usability, satisfaction, and communication effectiveness with the care team. During a multicenter, prospective randomized controlled trial, 153 AF patients were included in the AF-EduApp study, with a minimum follow-up of 12 months and a maximum follow-up of 15 months if taking oral anticoagulation (OAC). The AF-EduApp contains six main modules: Questionnaires, Education, Measurement data entry, Medication overview with reminders, Appointments, and Communication with the care team. The App focuses on four main goals: (1) to improve AF knowledge, (2) to increase self-care capabilities, (3) electronic monitoring to improve therapy adherence to OAC, and (4) communication with the care team. Patients unable to use the AF-EduApp were assigned to a no-App control group (n = 41) without intervention comparable to the standard care group (SC, n = 346) of the AF-EduCare study. A total of 152 patients effectively used the App during a mean follow-up of 386.8 ± 108. 1 days (one included patient could not install the application due to an iPhone from the United States). They opened the application on average on 130.1 ± 144.7 days. Of the 109 patients still in follow-up after 12 months (i.e. patients who did not withdraw and on OAC), 90 patients (82.6%) actively used the application at least one day in the next 41 days. The Measurement module was the most used, with a median of used days over the total available days of 6.4%. A total of 75 App patients (49.3%) asked questions, mostly clinical-related questions (e.g. medication use, or actionability on clinical entered parameters). A mean score of 8.1 ± 1.7 about the "perceived quality of follow-up in the past year" was given by the App ITT patients, compared to a score of 7.7 ± 2.0 by the SC group (P = .072). Patients who used the App were more attracted to future follow-up with an application compared to patients who would be capable of using the application of the SC group (31.6% vs. 12.5%; P < .001). This study showed a positive attitude towards using a mobile application, with AF patients using the application one-third of the available days. Patients used the App most for entering measured parameters, and to contact the care team.

Insight into the relationship between resting heart rate and atrial fibrillation: a Mendelian randomization study.

A low resting heart rate (RHR) implies a more efficient heart function and a lower risk of cardiovascular disease. However, observational studies have reported a U-shaped association between RHR and atrial fibrillation (AF). In contrast, Mendelian randomization (MR) studies have found an inverse causal association between RHR and AF. Hence, the causal nature of the relationship is not clear. The aim is to investigate the causal association and its shape between RHR on AF using linear and non-linear MR (NLMR). Linear and non-linear MR were performed on individual-level data in the Trøndelag Health Study (HUNT) and UK Biobank (UKB). HUNT consists of 69 155 individuals with 7,062 AF cases, while UKB provides data on 431 852 individuals with 20 452 AF cases. The linear MR found an inverse relationship between RHR and AF with an OR = 0.95 [95% confidence interval (CI): 0.93-0.98] and OR = 0.96 (95% CI: 0.95-0.97) per unit decrease in RHR in HUNT and UKB, respectively. The NLMR was supportive of an inverse linear relationship in both HUNT and UKB for RHR values <90 beats per minute (bpm). Several sensitivity analyses were also consistent. In contrast with the current observational knowledge of RHR and AF, an inverse causal association between RHR and AF was demonstrated in both linear and non-linear MR for RHR values up to 90 bpm. Further exploring the underlying mechanisms of the genetic instrument for RHR may shed light on whether pleiotropy is biasing this association.

Usability and Feasibility Testing of an Atrial Fibrillation Educational Website with Patients Referred to an Atrial Fibrillation Specialty Clinic.

The purpose of this study was to design, usability test, and explore the feasibility of a web-based educational platform/intervention for patients with atrial fibrillation (AF) as part of their virtual AF care. Participants were patients attending a specialized AF clinic. The multiple mixed-methods design included website design, think-aloud usability test, 1-month unstructured pre-testing analysis using Google Analytics, follow-up interviews, and a non-randomized one-group feasibility test using pre/post online surveys and Google Analytics. Usability testing participants (n = 2) guided adjustments for improving navigation. Pre-testing participants' (n = 9) website activity averaged four sessions (SD = 2.6) at 10 (SD 8) minutes per session during a 1-month study period. In the feasibility test, 30 patients referred to AF specialty clinic care completed the baseline survey, and 20 of these completed the 6-month follow-up survey. A total of 19 patients accessed the website over the 6 months, and all 30 participants were sent email prompts containing information from the website. Health-related quality of life, treatment satisfaction, household activity, and AF knowledge scores were higher at follow-up than baseline. There was an overall downward trend in self-reported healthcare utilization at follow-up. Access to a credible education website for patients with AF has great potential to complement virtual and hybrid models of care.

Managing With Atrial Fibrillation: An Exploratory Model-Based Cluster Analysis of Clinical and Personal Patient Characteristics

BackgroundExamining characteristics of patients with atrial fibrillation (AF) has the potential to help in identifying groups of patients who might benefit from different management approaches. MethodsSecondary analysis of online survey data was combined with clinic referral data abstraction from 196 patients with AF attending an AF specialty clinic. Cluster analyses were performed to identify distinct, homogeneous clusters of AF patients defined by 11 relevant variables: CHA2DS2-VASc score, age, AF symptoms, overall health, mental health, AF knowledge, perceived stress, household and recreation activity, overall AF quality of life, and AF symptom treatment satisfaction. Follow-up analyses examined differences between the cluster groups in additional clinical variables. ResultsEvidence emerged for both 2- and 4-cluster solutions. The 2-cluster solution involved a contrast between patients who were doing well on all variables (n = 129; 66%) vs those doing less well (n = 67; 34%). The 4-cluster solution provided a closer-up view of the data, showing that the group doing less well was split into 3 meaningfully different subgroups of patients who were managing in different ways. The final 4 clusters produced were as follows: (i) doing well; (ii) stressed and discontented; (iii) struggling and dissatisfied; and (iv) satisfied and complacent. ConclusionsPatients with AF can be accurately classified into distinct, natural groupings that vary in clinically important ways. Among the patients who were not managing well with AF, we found 3 distinct subgroups of patients who may benefit from tailored approaches to AF management and support. The tailoring of treatment approaches to specific personal and/or behavioural patterns, alongside clinical patterns, holds potential to improve patient outcomes (eg, treatment satisfaction).

Patient perspectives on same-day discharge following catheter ablation for atrial fibrillation: Results from a patient survey as part of the monocentric FAST AFA trial.

Same-day discharge (SDD) following catheter ablation (CA) of atrial fibrillation (AF) was already introduced in selected facilities in Europe but a widespread implementation has not yet succeeded. Data on patients' perspectives is lacking. Therefore, we conducted a survey to address patients' beliefs towards SDD and identify variables that are associated with their evaluation. As part of the prospective, monocentric FAST AFA trial, patients aged ≥20 years undergoing left atrial CA for AF were asked to participate in the survey consisting of a study-specific questionnaire, the AF knowledge scale and pre-defined PROMs. The study cohort was stratified based on SDD willingness and a logistic regression analysis was used to identify predictors for patients' valuation. Between 07/26/2021-07/01/2022, 256 of 376 screened patients consented to study participation of whom 248 (mean age 61.8 years, 33.9% female) completed the SDD survey. Of them, 50.0% were willing to have SDD concepts integrated into their clinical course with increased patient comfort (27.5%), shorter waiting times (14.6%) and a cost-efficient treatment (14.0%) being imaginable benefits. In contrast, expressed concerns included uncertainties with occurring complaints (50.6%), and the insufficient recognition (47.8%) and treatment (48.9%) of complications. EHRA class at baseline and inpatient treatments within the preceding year were predictors for SDD willingness whereas comorbidity burden or AF knowledge were not. We provide a detailed survey expressing patients' beliefs towards SDD following left atrial CA. Our findings may facilitate adequate patient selection to improve the future implementation of SDD programs in suitable cohorts.

A nurse-led multicomponent behavioral activation intervention for patients with atrial fibrillation: a randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Grants Committee of Hong Kong through the General Research Fund Introduction Patients with atrial fibrillation (AF) often play a passive role in the treatment decision-making process, rendering jeopardized health-related quality of life, suboptimal medication optimization and self-care. Purpose This study aimed to examine the effects of a Nurse-led Multicomponent Behavioral Activation (N-MBA) intervention on HRQoL, knowledge about AF, medication adherence and psychological distress among patients with AF. Methods This parallel two-arm randomized controlled trial recruited community-dwelling patients aged ≥65 years with a confirmed diagnosis of atrial fibrillation, moderate to high risk of stroke but not receiving oral anticoagulation. Participants were randomized in a 1:1 ratio to receive the N-MBA intervention or standard care. The 13-week intervention adopted a novel behavioral activation approach to equip AF patients as an active agent to manage the disease. It consisted of care components to prepare patients for shared decision-making by using a decision aid, an empowerment-based educational module covering relevant AF self-care topics and continuous support through telephone calls. A set of validated instruments was administered at baseline, immediate and 6 months post-intervention. Results A total of 252 participants were randomized to the intervention (n = 127) or control (n = 125) group. Compared with the control group, the intervention group showed greater improvements in HRQoL [β = 10.617, 95% confidence interval (CI) = 1.285 – 20.501, p = 0.023] and AF knowledge (β = 2.129, 95% CI =1.026 – 5.712, p &amp;lt;0.001) at immediate post-intervention. The effects on both outcomes sustained at 6-month follow-up time point. No significant between-group changes in medication adherence, anxiety and depression were detected. Participants in the intervention group were activated to raise their concerns about AF and its treatment with the attending doctors, and they perceived higher compatibility between patient and physician decisions of OAC use upon completion of the intervention. Conclusion The empowerment-based nurse-led intervention is effective at sustaining improvements in HRQoL, AF knowledge and treatment decision making in AF patients with moderate to high stroke risk. It does not increase their psychological distress.

Assessment of the general public’s knowledge of atrial fibrillation through social media: a cross-sectional study

BackgroundEarly detection and timely treatment of atrial fibrillation (AF) remains pivotal to preventing AF-related complications. Public involvement in recognising potential AF symptoms and managing AF is vital for early detection and treatment of AF.ObjectiveThe aim of the study is to assess the general public’s knowledge of AF using an online survey, disseminated via social media.MethodsA cross-sectional online survey of the general public was conducted between November to December 2021. The survey’s URL was shared on National University Heart Centre, Singapore’s official Facebook page. Digital marketing strategies were employed to recruit members of the public. The 27-item survey assessed public’s knowledge across five domains: basic information about AF, risk factors of AF, detection of AF, prevention of AF, and management of AF.ResultsThe survey involved 620 participants. Approximately two-thirds were between the ages 21 to 40 years (64.5%), female (60%) and had at least a degree (64.7%) as their highest level of education. Participants obtained a mean percentage score of 63.3 ± 26.0 for their AF knowledge. One-way ANOVA was done to examine the associations between the participants’ characteristics and their knowledge of AF. There were no statistically significant differences in the AF knowledge scores across the various sociodemographic subgroups.ConclusionsMembers of the public recruited from Facebook and via digital marketing had moderately good knowledge of AF. However, public awareness pertaining to preventing AF has potential for improvement. The utility of social media in reaching the general public was illustrated through this study.

An instrument to measure atrial fibrillation knowledge in Chinese patients: validation of the Jessa Atrial fibrillation Knowledge Questionnaire.

Background: There is no validated tool to assess patients' knowledge of oral anticoagulant therapy in atrial fibrillation in China. Methods: Using a standard translation program, the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ) was translated into Chinese. The reliability of the JAKQ was assessed by internal consistency (Cronbach's α coefficient), repeatability (test-retest reliability), and sensitivity tests. Effectiveness was assessed by hypothesizing that a lower JAKQ score was a risk factor for bleeding. A total of 447 patients with atrial fibrillation (AF) who were hospitalized between July 2019 and December 2021 were studied and followed up. Participants were followed up 1, 3, 6, and 12 months after enrollment. Bleeding during follow-up was recorded. Data were obtained from hospital databases and telephone follow-up. Result: A total of 447 patients with AF completed JAKQ. The mean age of patients was 67.7 ± 10.2years. The median JAKQ score was 31.3% (12.5-43.8). The Cronbach's α coefficient of JAKQ was 0.616-0.637, and the test-retest reliability value was 0.902 (p < 0.001). Multivariate logistic regression showed that the higher knowledge level of AF was associated with secondary education or above, an income of more than 2000 yuan, and a history of AF of more than 1year. Bleeding was associated with a lower JAKQ score, hypertension, and a history of bleeding. Non-bleeding patients on VKA had a better understanding of how often INR should be monitored and what to do if an OAC dose was missed. Conclusion: The Chinese version of JAKQ shows good reliability and validity, indicating that it is a valuable tool for AF and oral anticoagulation (OAC) knowledge assessment. It can be used in clinical practice to guide educational activities and improve the effectiveness and safety of treatment. It was shown that Chinese patients with AF have insufficient knowledge about AF and OAC. Lower JAKQ scores are associated with bleeding, so targeted education is necessary. Targeted educational efforts should focus on patients recently diagnosed with AF and those with lower formal education and income.

Patient perspectives on same-day discharge following catheter ablation for atrial fibrillation: results from the FAST AFA trial

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This study was financially supported by Biosense Webster. Introduction Same-day discharge (SDD) protocols following catheter ablation (CA) of atrial fibrillation (AF) were already introduced in selected facilities in Europe but a widespread implementation has not yet succeeded. Data on patients’ perspectives to support early discharge regimens is lacking. Therefore, we conducted a survey to address patients’ beliefs towards SDD and identify variables that are associated with their evaluation. Methods As a part of the prospective, monocentric FAST AFA trial, patients aged ≥20 years undergoing a left atrial CA for AF or atrial flutter were asked to participate in the survey consisting of a study-specific SDD-questionnaire, the AF knowledge scale and pre-defined patient reported outcome measures. The study cohort was stratified based on SDD willingness and a logistic regression analysis was used to identify predictors for patients’ valuation. Results Between 07/26/2021-07/01/2022, 256 of 376 screened patients consented to study participation of whom 248 (median age 61.8 years, 33.9% female) completed the SDD survey. Of them, 50.0% were willing to have SDD concepts integrated into their clinical course with increased patient comfort (27.5%), shorter waiting times (14.6%) and a cost-efficient treatment (14.0%) being imaginable benefits. In contrast, 52.2% of patients saw no advantages in SDD and expressed concerns including uncertainties with occurring complaints (50.6%), as well as the insufficient recognition (47.8%) and treatment (48.9%) of complications. Symptoms at baseline and inpatient treatments within the preceding year were predictors for SDD willingness whereas comorbidity burden or AF knowledge were not. Conclusion We provide a detailed survey expressing patients’ beliefs towards SDD following left atrial CA. Our findings may facilitate adequate patient selection to improve the future implementation of SDD programs in suitable cohorts.

Nurse-led multi-component behavioural activation programme to improve health outcomes in patients with atrial fibrillation: a mixed-methods study and feasibility analysis.

Patients with atrial fibrillation (AF) play passive roles in disease management. This study aimed to examine the feasibility and preliminary effects of an empowerment-based care model, titled 'the nurse-led multi-component behavioural activation (N-MBA) programme', on health-related quality of life, AF knowledge, psychological outcomes, medication adherence, and treatment decision-making in patients with AF. This mixed-methods study comprised a pilot randomized controlled trial and a qualitative study. Patients with AF who had a moderate-to-high risk of stroke but were not prescribed oral anticoagulants were recruited. Forty participants were recruited and randomized in a 1:1 ratio to receive either the N-MBA programme or standard care. The 13-week programme comprised care components that prepared patients for shared decision-making, an empowerment-based educational module on AF self-care, and continuous support through telephone calls. The programme was feasible, and the overall attendance rate was 82.5%. The participants gave excellent ratings in the satisfaction survey. The N-MBA group showed greater improvements in health-related quality of life (HRQoL) and AF knowledge than the standard care group at the immediate post intervention and 6-month follow-up time points. No significant between-group changes in medication adherence, anxiety, and depression were detected. Participants in the N-MBA group actively raised concerns about AF and its treatment with their attending doctors. The qualitative data were consistent with the quantitative data, indicating that the programme built a comprehensive knowledge base of AF and self-care behaviours. The N-MBA programme is feasible and acceptable to patients with AF. It improved patients' AF knowledge, treatment-related decision-making, and HRQoL. ClinicalTrials.gov NCT03924739.

Abstract 13482: Feasibility Analysis of a Nurse-Led Empowerment-Based Care Model in Supporting Treatment Decision-Making and Self-Care Among Patients With Atrial Fibrillation

Introduction: Patients with atrial fibrillation (AF) play a passive role in the treatment decision-making process, rendering suboptimal medication optimization and poor self-care. This pilot study aimed to examine the feasibility and preliminary effects of a nurse-led empowerment-based intervention among AF patients. Methods: This study comprised a pilot randomized controlled trial and an exploratory qualitative phase. AF patients who had moderate to high risk of stroke but not receiving oral anticoagulation were recruited. Participants (N = 40) were randomized in 1:1 ratio to receive the intervention or standard care. The 13-week intervention adopted a novel behavioral activation approach to equip AF patients as an active agent to manage the disease. It consisted of care components to prepare patients for shared decision-making by using a decision aid, an empowerment-based educational module covering relevant AF self-care topics and continuous support through telephone calls. Ten participants in the intervention group attended a qualitative interview to explore their engagement experience and perceived feasibility. Results: The intervention was highly feasible and participants gave excellent rating for the satisfaction survey. The overall attendance rate was 82.5%. Compared with the standard care group, the intervention group showed greater improvements in health-related quality of life (HRQoL) [β = -10.617, (95% CI = -20.350 - -0.885), p = 0.033] and AF knowledge [β = 1.950, (95% CI =1.026 - 2.874), p &lt;0.001] at immediate post-intervention. The effects on both outcomes sustained at 6-month follow-up time point. No significant between-group changes in medication adherence, anxiety and depression were detected. Participants in the intervention group were activated to raise their concerns about AF and its treatment with the attending doctors. The qualitative data highlighted the uniqueness of the empowerment process of the intervention in improving their knowledge and self-care behaviors. Conclusions: The empowerment-based nurse-led intervention is highly feasible and acceptable for AF patients. It improved HRQoL, AF knowledge and treatment decision making in AF patients. It did not increase anxiety and depression.