Long-term benefits of education by emergency care nurses at discharge of patients with atrial fibrillation

Fuenzalida, Carolina; Hernández, Gritzel; Ferro, Inês; Siches, Carme; Ambrós, Àngels; Coll-Vinent, Blanca

doi:10.1016/j.ienj.2017.03.006

Cited by 23 publications

(48 citation statements)

References 26 publications

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“…After reviewing titles and abstracts, 50 full‐text references were potentially eligible for inclusion. After examining the full‐text references, ten references (two systematic reviews and eight RCTs) were included for data extraction and analysis 18‐26 . The selection process is summarised in the flow chart shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

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Educational interventions to improve outcomes in patients with atrial fibrillation—a systematic review

Palm

Qvist

Rasmussen

et al. 2020

Int. J. Clin. Pract.

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Background: Atrial fibrillation (AF) is an emerging epidemic associated with poor mental health and quality of life, as well as morbidity and mortality. Whilst other cardiovascular conditions have demonstrated positive outcomes from educational programmes, this approach is not well integrated in clinical practice in patients with AF. Though evidence in this area is mounting, a thorough overview seems to be lacking. Aim: To assess benefits and harms of educational interventions compared with no intervention in adults with AF. Method: A systematic review and meta-analysis were performed including the outcomes: Serious adverse events (mortality and readmission), mental health (anxiety and depression), physical capacity, quality of life and self-reported incidence of symptoms of AF. PubMed, Embase, CINAHL, Cochrane Library and PsycINFO were searched between June and august 2018. Data extraction and quality assessment were performed independently by two reviewers. The Cochrane Risk of Bias tool was applied for the randomised controlled trials and the Amstar Checklist for the systematic reviews. Results: Eight randomised controlled trials and one non-randomised interventional study were included, with a total of 2388 patients. Comparing with controls patient education was associated with a reduction in: Serious adverse events (Risk Ratio 0.78, CI 95% 0.63-0.97), anxiety with a mean difference of −0.62 (CI 95% −1.21, −0.04) and depression with a mean difference of −0.74 (CI 95% −1.34, −0.14). Health-related quality of life and physical capacity was found to increase after patient education, yet, only one study found statistically significant differences between groups. No differences were observed with regards to self-reported incidence of symptoms of AF. Conclusions: Educational interventions significantly decrease the number of serious adverse events in patients with AF and seem to have a positive impact on mental health and self-reported quality of life. However, the evidence is limited, and more studies are warranted.

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Section: Resultsmentioning

confidence: 99%

“…Altogether we included nine original trials of which eight were RCTs 18‐24,28 and one was a non‐randomised interventional study 27 . Three trials were identified both in the systematic reviews and the RCT search 22‐24 …”

Section: Resultsmentioning

confidence: 99%

Educational interventions to improve outcomes in patients with atrial fibrillation—a systematic review

Palm

Qvist

Rasmussen

et al. 2020

Int. J. Clin. Pract.

View full text Add to dashboard Cite

show abstract

“…Our findings demonstrate positive outcomes of delivering a tailored messaging intervention to patients with AF. Though similar to prior work, [20][21][22][23] our study focused on continued education via a health technology approach (EHR patient portal) with which patients were familiar. Relative to the control group, the intervention group participants logged into MyChart ® significantly more often during the study period and had higher AF knowledge scale scores at exit.…”

Section: Discussionmentioning

confidence: 99%

“…One-time educational sessions have been associated with higher warfarin adherence at six months 20 and lower AF-related complications at one year. 21 Other studies have assessed the impact of continual education interventions, including a combined health education and reminder calendar model that resulted in increased dabigatran adherence across one year 22 and a smartphone app with clinical decision support and education that was found to increase adherence, AF knowledge, quality of life, and OAC satisfaction at one and three months. 23 These studies, combined, illustrate the potential for increasing adherence and other positive outcomes via AF patient education.…”

Section: Introductionmentioning

confidence: 99%

Engaging Patients in Atrial Fibrillation Management via Digital Health Technology: The Impact of Tailored Messaging

Toscos¹,

Coupe²,

Wagner³

et al. 2020

J Innov Cardiac Rhythm Manage.

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Patients with atrial fibrillation (AF) demonstrate persistent knowledge gaps regarding their condition and a substandard adherence to oral anticoagulant (OAC) medication, which contribute to thromboembolic stroke and other clot-related complications. Tailored patient education and medication reminders may help reduce these negative health outcomes. We sought to improve disease knowledge and medication adherence among a sample of AF patients using tailored education and nudges. The intervention leveraged three digital health technologies: a patient portal, an electronic-prescribing data feed, and a smart pill bottle. The content of the educational messaging, nudges, and cadence were tailored according to findings from our user-centered design studies and delivered via a patient portal (MyChart ® ; Epic Systems, Verona, WI, USA), with which participants were familiar. In a six-month randomized controlled trial with parallel groups, we used MyChart ® to send educational messages and medication reminders according to a decision tree that emerged from our prior user-centered design studies. The intervention group demonstrated higher AF knowledge at study completion than the control group and more MyChart ® logins throughout the trial, suggesting intervention uptake. Women were more adherent than men and patients diagnosed more than one year ago were more adherent than those with more recent diagnoses. The intervention and control group adherence rates were 93.1% and 89.5%, respectively; intervention effect was moderated by age, medication type, and prior MyChart ® use. Within the intervention group, younger patients, those taking once-daily rivaroxaban, and those who were less active MyChart ® users prior to the study benefited relative to their control group counterparts. Tailored educational and reminder messages contributed to increased adherence and disease knowledge among AF patients, though certain patient characteristics moderated the intervention's effectiveness. Technology-based health interventions can be useful for older adults with effective tailoring and training.

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“…34 Nonetheless, dedicated programs that engage ED providers in patient education at the time of discharge have been demonstrated to decrease AF-related complications at one year of follow-up. 35 These studies underscore the need for systematic care for such patients.…”

Section: Shared Decision-making For Anticoagulation For Atrial Fibrilmentioning

confidence: 99%

Shared Decision-Making as the Future of Emergency Cardiology

Probst

Noseworthy

Brito

et al. 2018

Canadian Journal of Cardiology

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Shared decision-making is playing an increasingly large role in emergency cardiovascular care. Although there are many challenges to successfully performing shared decision-making in the emergency department, there are numerous clinical scenarios in which it should be used. In this article, we explore new research and emerging decision aids in the following emergency care scenarios: (1) low-risk chest pain; (2) new-onset atrial fibrillation; and (3) moderate-risk syncope. These decision aids are designed to engage patients and facilitate shared decision-making for specific treatment and disposition (admit vs discharge) decisions. We then offer a 3-step, practical approach to performing shared decision-making in the acute care setting, on the basis of broad stakeholder input and previous conceptual work. Step 1 involves simply acknowledging that a clinical decision needs to be made. Step 2 involves a shared discussion about the working diagnosis and the options for care in the context of the patient's values, preferences, and circumstances. The third and final step requires the patient and provider to agree on a plan of action regarding further medical care. The implementation of shared decision-making in emergency cardiology has the potential to shift the paradigm of clinical practice from paternalism toward mutualism and improve the quality and experience of care for our patients.

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Long-term benefits of education by emergency care nurses at discharge of patients with atrial fibrillation

Cited by 23 publications

References 26 publications

Educational interventions to improve outcomes in patients with atrial fibrillation—a systematic review

Educational interventions to improve outcomes in patients with atrial fibrillation—a systematic review

Engaging Patients in Atrial Fibrillation Management via Digital Health Technology: The Impact of Tailored Messaging

Shared Decision-Making as the Future of Emergency Cardiology

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