A Nurse-led Approach to Improving Cardiac Lifestyle Modification in an Atrial Fibrillation Population

Abstract

Atrial fibrillation (AF) is a major public health problem and the most common cardiac arrhythmia encountered in clinical practice at this time. AF is associated with numerous symptoms such as palpitations, shortness of breath, and fatigue, which can significantly reduce health-related quality of life and result in serious adverse cardiac outcomes. In light of this, the aim of the present pilot study was to test the feasibility of implementing a mobile health (mHealth) lifestyle intervention titled "Atrial Fibrillation and Cardiac Health: Targeting Improving Outcomes via a Nurse-Led Intervention (ACTION)," with the goal of improving cardiac health measures, AF symptom recognition, and self-management. As part of this study, participants self-identified cardiac health goals at enrollment. The nurse used web-based resources from the American Heart Association (Dallas, TX, USA), which included the Life's Simple 7 ® My Life Check ® assessment, to quantify current lifestyle behavior change needs. Furthermore, on the My AFib Experience™ website (American Heart Association, Dallas, TX, USA), the patient used a symptom tracker tool to capture the date, time, frequency, and type of AF symptoms, and these data were subsequently reviewed by the cardiac nurse. Throughout the six-month intervention period, the cardiac nurse used a motivational interviewing approach to support participants' cardiac health goals. Ultimately, the ACTION intervention was tested in 53 individuals with AF (mean age: 59 ± 11 years; 76% male). Participants were predominantly overweight/obese (79%), had a history of hypertension (62%) or hyperlipidemia (61%), and reported being physically inactive/not preforming any type of regular exercise (52%). The majority (88%) of the participants had one or more Life's Simple 7 ® measures that could be improved. Most of the participants (98%) liked having a dedicated nurse to work with them on a biweekly basis via the mHealth portal. The most commonly self-reported symptoms were palpitations, fatigue/exercise intolerance, and dyspnea. Seventy percent of the participants had an improvement in their weight and blood pressure as documented within the electronic health record as well as a corresponding improvement in their Life's Simple 7 ® score at six months. On average, there was a three-pound (1.36-kg) decrease in weight and a 5-mmHg decrease in systolic blood pressure between baseline and at six months. In conclusion, this pilot work provides initial evidence regarding the feasibility of implementing the ACTION intervention and supports testing the ACTION intervention in a larger cohort of AF patients to inform existing AF guidelines and build an evidence base for reducing AF burden through lifestyle modification.

A nurse‐led atrial fibrillation clinic: Impact on anticoagulation therapy and clinical outcomes

“…A randomised clinical trial also demonstrated that nurse-led care of patients with AF is superior to routine clinical care, reducing the risk of cardiovascular death (HR 0.28; 95% CI 0.09-0.85, P = .025) and cardiovascular hospitalisation (HR 0.66; 95% CI 0.46-0.96, P = .029) 42. This has been proposed in other studies where nurse-led clinics showed to contribute on sustained follow-up care, preventing hospitalisations, improving outcomes, reducing AF burden through lifestyle modification and addressing current deficiencies in AF management [43][44][45]. Furthermore, an ongoing trial aims to assess the effect of nurse practitioner-led care on the health-related quality of life in patients with AF, as well as to measure its impact on relevant outcomes such as death, hospitalisation and emergency department visits 46.…”

Stroke Counseling Intervention for Young Adult African Americans

“…The SCORRE intervention, designed for young AAs, improved their accuracy of perceived stroke risk, perceived competence to live a healthy lifestyle, and lifestyle behaviors, specifically dietary behaviors. Similar nurse-led, community-based interventions that used the AHA LS7 program to counsel/coach individuals at risk of cardiovascular disease found that the interventions were feasible and improved health behaviors and cardiovascular health outcomes—but in older adults (Hickey et al, 2019; Murphy et al, 2015). Older, White adults and secondary stroke prevention have been the targets for other successful, nurse-led, community-based interventions (Kosub, 2010; Lawrence et al, 2011).…”

Improving hypertension control and cardiovascular health: An urgent call to action for nursing

“…This includes the following: Teaching patients to accurately use and calibrate their home BP monitors (Parati et al, 2021 ). Using motivational interviewing in serving as a health coach (Hickey et al, 2019 ). …”