Education of Self-Radial Pulse Palpation and Atrial Fibrillation Signs and Symptoms

Voelliger, Cara M.; Vanderzwan, Kathryn J.; Coyne, Edmund; Hu, Yuhning L.; Shammas, Nicolas W.; Lisius, Kelsey; King, Maripat; Lemke, Jon H.

doi:10.1080/07370016.2021.1932973

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…This indicates that many patients are being diagnosed following a major AF-related symptom or crisis (e.g., stroke). Evidence suggest that, anywhere from 10 to 40% of patients with AF are asymptomatic 29,30 , this is likely to result in a considerable number of undiagnosed AF in LMIC settings where screening and assessment of AF risk in primary care is not routine, as our result suggest 31 . To enable early diagnosis of symptomatic and silent AF before a medical crisis 32 and reduce poor prognosis and high healthcare costs 12 , the primary care system must be strengthened.…”

Section: Discussionmentioning

confidence: 61%

The pathway to diagnosis and follow-up care for atrial fibrillation in Sri Lanka: a descriptive longitudinal study

Antony Sheron,

Gooden,

Uruthirakumar

et al. 2024

NIHR Open Res

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Background Early diagnosis and continuity of care is vital for atrial fibrillation (AF), to reduce stroke ; There is a lack of understanding of when and how AF is being diagnosed and managed the care pathway) in in low- and middle-income countries (LMICs). We aimed to identify the AF care pathway in Northern Province, Sri Lanka and determine how the COVID-19 pandemic impacted the care pathway. Methods This descriptive longitudinal study utilised two quantitative questionnaires to evaluate the AF pathway: The first questionnaire (baseline) was used to identify where AF was being diagnosed and the second questionnaire (3 months following baseline) was used to identify where and how often AF follow-up care was being received. How the COVID-19 pandemic impacted the care pathway was asked in the second questionnaire. We aimed to recruit 236 adults (≥18 years) with AF from Jaffna Teaching Hospital. Data were collected between October 2020 and June 2021 and analysed using descriptive statistics. Results 151 participants were recruited (median age 57 years; 70% female). Most participants were diagnosed in the accident & emergency (38%) or inpatient department (26%), followed by an outpatient department (19%) or private facility (16%). Nearly all (97%) participants received follow-up care during the study period, with an average of 1.3 AF-related healthcare visits per person for a month; most visited an outpatient department (88%). The COVID-19 pandemic negatively impacted 39% of participants’ care: healthcare visits were reduced or, delayed or medications were unattainable, and longer intervals between blood tests were experienced; however, 24% of participants were able to receive their medication by ambulance, public health staff or post during lockdowns. Conclusions Primary care was not involved in the diagnosis of AF, indicating that most diagnoses occurr after a medical emergency. The frequency of blood tests was lower than the guideline recommendations of one per month which could in-part be due to the adverse impacts of the pandemic. Strengthening primary and community-based care may enable early diagnosis and improve continuity of care during and beyond future healthcare crises.

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Section: Discussionmentioning

confidence: 61%

The pathway to diagnosis and follow-up care for atrial fibrillation in Sri Lanka: a descriptive longitudinal study

Antony Sheron,

Gooden,

Uruthirakumar

et al. 2024

NIHR Open Res

View full text Add to dashboard Cite

show abstract

“…This leads to the supposition that many patients are diagnosed following a major AF-related symptom or crisis (e.g., stroke). If we assume that an estimated 10 to 40% of patients with AF are asymptomatic based on evidence from other settings 29,30 , there may be a considerable number of undiagnosed AF in the community; a concerning, but not uncommon reality in an LMIC setting 31 . To enable early diagnosis of symptomatic and silent AF before a medical crisis 32 and reduce poor prognosis and high healthcare costs 12 , the primary care system must be strengthened.…”

Section: Discussionmentioning

confidence: 99%

The pathway to diagnosis and follow-up care for atrial fibrillation in Sri Lanka: a descriptive longitudinal study

Antony Sheron,

Gooden,

Uruthirakumar

et al. 2023

NIHR Open Res

View full text Add to dashboard Cite

Background Early diagnosis and continuity of care is vital for atrial fibrillation (AF), a major risk factor for stroke that requires regular monitoring when treated with warfarin; however, evidence on AF care in LMICs is lacking. We aimed to identify the AF patient pathway in Northern Province, Sri Lanka and to determine how the COVID-19 pandemic impacted AF care. Methods This descriptive longitudinal study utilised two questionnaires, which were previously used in India and Mongolia to quantitatively evaluate the AF pathway: one at baseline and one ≥3 months following baseline. Adults (≥18 years) with AF were recruited from the A&E department and outpatient clinics located at the Jaffna Teaching Hospital, the only tertiary hospital with cardiologists and 12-lead echocardiogram facilities in the Province. Data were collected between October 2020 and June 2021 and analysed using descriptive statistics. Results This study included 151 participants (median age 57 years, IQR 49-67; 70% female). Most participants were diagnosed in the A&E (38%) or inpatient department (26%), followed by an outpatient department (19%) or private facility (16%). Nearly all (97%) participants received follow-up care during the study period, with an average of 1.3 AF-related healthcare visits per person; most visited an outpatient department (88%). The COVID-19 pandemic negatively impacted 39% of participants’ care: fewer healthcare visits, delayed or unattainable medications, and longer intervals between blood tests; however, 24% of participants received their medication by ambulance, public health staff or post. Conclusions Primary care was not involved in the diagnosis of AF, leading to most diagnoses occurring after a medical emergency. The frequency of blood tests was lower than guideline recommendations and could in-part be due to the adverse impacts of the pandemic. Strengthening primary and community-based care may enable early diagnosis and improve continuity of care during and beyond future healthcare crises/emergencies.

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“…HR was intermittently assessed by manual radial palpation. Due to its simplicity, this is a highly established and reliable technique for HR measurements which can also be employed by non-professionals following a brief introduction [ 37 – 39 ]. The mAST was combined with a detailed written step-by-step instruction.…”

Section: Methodsmentioning

confidence: 99%

The baroreceptor reflex brought to life outside the classroom – an e-learning based asynchronous laboratory class using a non-supervised modified Active Standing Test

et al. 2022

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Background E-learning based laboratory classes can replace or enhance in-classroom laboratories. They typically offer temporal flexibility, self-determined learning speed, repeatability and do not require supervision or face-to-face contact. The aim of this feasibility study was to investigate whether the established in-classroom laboratory class on the baroreceptor reflex (BRR) can be transformed into a new e-learning based asynchronous laboratory class for untrained, non-supervised students without medical equipment. The BRR is a fundamental cardiovascular process which is regularly visualized in physiology during in-classroom laboratories by a student-performed Active Standing Test (AST). During this voluntary provocation of orthostatic stress, the BRR reliably causes a solid rise in heart rate (HR) and a stabilization or even increase in blood pressure (BP). Methods The conventional AST was modified by omission of BP measurements which would require medical devices and was embedded into a framework of interactive digital material allowing independent student performance. With specific adaptions, this instrument was implemented to 1st and 2nd year curricula of human medicine, dental medicine, midwifery and pharmacy. An audience response system was used to collect the students’ data on HR, epidemiology, technical problems, satisfaction and orthostatic symptoms. As primary outcome, we investigated the students’ correct performance of the modified AST regarding textbook conformity of the HR data. Secondary outcomes included technical feasibility, the students’ satisfaction and consistency of HR data within predefined subgroups (e.g., gender, curricula). Descriptive statistics are reported. Results The class was completed by 217 students (mean age: 23 ± 8 [SD], 81% female, 19% male). Mean reported rise of HR during standing was ~ 20 bpm (~ 30%) which is highly concordant to textbooks. Reported feasibility (~ 80% negated any technical issues) and students’ satisfaction (4.4 on 5-point Likert-scale) were high. The HR data were consistent within the subgroups. Conclusion This study demonstrates that the highly relevant BRR can be successfully addressed in an e-learning based asynchronous laboratory class implementing a non-supervised AST restricted to HR measurements embedded in digital material. The robust HR response and the adjustable complexity allow an application to different healthcare-related curricula. This class, therefore, provides a broad audience access to a fundamental concept of cardiovascular physiology.

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Education of Self-Radial Pulse Palpation and Atrial Fibrillation Signs and Symptoms

Cited by 3 publications

References 7 publications

The pathway to diagnosis and follow-up care for atrial fibrillation in Sri Lanka: a descriptive longitudinal study

The pathway to diagnosis and follow-up care for atrial fibrillation in Sri Lanka: a descriptive longitudinal study

The pathway to diagnosis and follow-up care for atrial fibrillation in Sri Lanka: a descriptive longitudinal study

The baroreceptor reflex brought to life outside the classroom – an e-learning based asynchronous laboratory class using a non-supervised modified Active Standing Test

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