Management of newly diagnosed atrial fibrillation in an outpatient clinic setting—patient's perspectives and experiences

Thrysoee, Lars; Strömberg, Anna; Brandes, Axel; Hendriks, Jeroen

doi:10.1111/jocn.13951

Cited by 26 publications

(49 citation statements)

References 46 publications

(45 reference statements)

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“…We believe that our study ndings have signi cant implications for clinical practice and policy. Our ndings regarding the knowledge de cit of patients being the primary reason for minimal involvement of patients in decision-making regarding the treatment options for stroke prevention were consistent with previous studies (23,24,36). Educational interventions by health professionals are highly recommended to the public, especially aimed at patients with AF and their caregivers.…”

Section: Discussionsupporting

confidence: 87%

“…Many studies have reached similar conclusions. Thrysoee et al reported patients in their study did not understand the association between AF, stroke, and anticoagulation so they were not actively involved in the decision-making process and took the medication as prescribed by the physician (36). In addition, a systematic review previously reported that patients' high level of con dence in physicians' professional knowledge and training was one of the reasons for decision delegation (24).…”

Section: Discussionmentioning

confidence: 99%

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Understanding the Barriers to Using Oral Anticoagulants Among Long-Term Aspirin Users With Atrial Fibrillation – A Qualitative Study

Siu

Chiu

et al. 2020

Preprint

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Background: Despite international treatment guidelines currently advocating oral anticoagulants (OACs) as the only appropriate stroke prevention therapy for patients with atrial fibrillation (AF) and evidence that OACs can greatly reduce the risk of stroke with similar risk of bleeding compared with aspirin, the underuse of OACs in patients with AF is common globally, especially in Asia. This study aimed to identify the barriers to prescribing and using OACs among long-term aspirin users with AF.Method: Face-to-face interviews were conducted with fourteen eligible patients with AF using a semi-structured interview guide. The interview recordings were transcribed verbatim and data was analyzed according to the principles of thematic analysis.Results: Five themes were developed: awareness of AF symptoms and diagnosis; knowledge and understanding of AF and stroke prevention therapy; role of decision-making in prescribing; willingness to switch from aspirin to OACs; and impact of OAC regimen on daily living. The majority of the patients were not aware of the symptoms and diagnosis of AF and only had a vague understanding of the illness and stroke prevention therapy, leading to their minimal involvement in decisions relating to their treatment. Some patients and their caregivers were particularly concerned about the bleeding complications from OACs and perceived aspirin to be a suitable alternative as they find the adverse effects from aspirin manageable and so preferred to remain on aspirin if switching to OACs was not compulsory. Lastly, the lifestyle modifications required when using warfarin, e.g. alternative dosing regimen, diet restriction, were seen as barriers to some patients and caregivers. Conclusion: The findings revealed patients’ knowledge gap in AF management which may be targeted using educational interventions to improve patients’ understanding of AF and its management and hence encourage active participation in the decision-making of their treatment in the future.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Understanding the Barriers to Using Oral Anticoagulants Among Long-Term Aspirin Users With Atrial Fibrillation – A Qualitative Study

Siu

Chiu

et al. 2020

Preprint

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“…16 Other work has found that patients were uncertain what AF was before and after outpatient cardiology clinic appointments. 17 They also had difficulty understanding why they were treated with anticoagulation and why treatment was recommended lifelong. 17 Older patients, in particular, may have a poor understanding of AF.…”

Section: Findings In Relation To Other Studiesmentioning

confidence: 99%

“…17 They also had difficulty understanding why they were treated with anticoagulation and why treatment was recommended lifelong. 17 Older patients, in particular, may have a poor understanding of AF. 18 This may be a key barrier to accepting anticoagulation treatment and to future treatment adherence, which is imperative for stroke risk reduction.…”

Section: Findings In Relation To Other Studiesmentioning

confidence: 99%

Patients’ views about screening for atrial fibrillation (AF): a qualitative study in primary care

et al. 2020

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ObjectivesThere has been increased interest in screening for atrial fibrillation (AF) with commissioned pilot schemes, ongoing large clinical trials and the emergence of inexpensive consumer single-lead ECG devices that can be used to detect AF. This qualitative study aimed to explore patients’ views and understanding of AF and AF screening to determine acceptability and inform future recommendations.SettingA single primary care practice in Hampshire, UK.Participants15 participants (11 female) were interviewed from primary care who had taken part in an AF screening trial. A semistructured interview guide was used flexibly to enable the interviewer to explore any relevant topics raised by the participants. Interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis.ResultsParticipants generally had an incomplete understanding of AF and conflated it with other heart problems or with raised blood pressure. With regards to potential drawbacks from screening, some participants considered anxiety and the cost of implementation, but none acknowledged potential harms associated with screening such as side effects of anticoagulation treatment or the risk of further investigations. The screening was generally well accepted, and participants were generally in favour of engaging with prolonged screening.ConclusionsOur study highlights that there may be poor understanding (of both the nature of AF and potential negatives of screening) among patients who have been screened for AF. Further work is required to determine if resources including decision aids can address this important knowledge gap and improve clinical informed consent for AF screening.Trial registration numberISRCTN 17495003.

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“…Generally speaking, a new diagnosis of AF can be overwhelming 4. Inevitably, patients will be bombarded at their initial clinic visit with a tremendous amount of new information.…”

mentioning

confidence: 99%

What do our patients think they know about atrial fibrillation? … Is that asking the right question?

Bhave

2017

Heart

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Management of newly diagnosed atrial fibrillation in an outpatient clinic setting—patient's perspectives and experiences

Abstract: This study demonstrates some lack of patient-centred care and an absence of tailored patient AF-related education. Furthermore, the study highlights the need for and importance of active patient involvement.

Cited by 26 publications

References 46 publications

Understanding the Barriers to Using Oral Anticoagulants Among Long-Term Aspirin Users With Atrial Fibrillation – A Qualitative Study

Understanding the Barriers to Using Oral Anticoagulants Among Long-Term Aspirin Users With Atrial Fibrillation – A Qualitative Study

Patients’ views about screening for atrial fibrillation (AF): a qualitative study in primary care

What do our patients think they know about atrial fibrillation? … Is that asking the right question?

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