Patient activation for self-management is associated with health status in patients with atrial fibrillation

Abstract

BackgroundHigher levels of patient activation for self-managing health are associated with positive clinical and health care utilization outcomes. Identifying a patient’s activation level can guide clinicians to tailor interventions to improve their health. Effective self-management of atrial fibrillation (AF) requires patient activation to participate in treatment decisions, prevent complications, and manage risk factors. Yet, little is known about activation in patients with AF. The purpose of this descriptive study was to identify patient activation levels and factors associated with activation in patients with AF.MethodsPatients (N=123), 66% male, with a mean (SD) age of 59.9 (11.3) years seeking treatment for AF at an arrhythmia clinic completed the Patient Activation Measure (PAM), Atrial Fibrillation Severity Scale, Knowledge about Atrial Fibrillation test, Hospital Anxiety Depression Scale, Godin Leisure-Time Exercise Questionnaire, and Patient Assessment of Chronic Illness Care. Sociodemographic and clinical data were obtained from medical records. PAM scores were categorized into Levels 1–4. Associations among patient-reported outcomes, sociodemographic, and clinical variables were analyzed using Fisher’s exact tests and Kruskal–Wallis procedures.ResultsThe PAM scores of nearly half (45.5%) of the patients were at Level 3, while the scores of 38% were at Level 4. Male sex (P=0.02), higher education (P=0.004), being employed (P=0.005), lower body mass index (P=0.03), tobacco abstinence (P=0.02), less AF symptom burden (P=0.006), less depression (P≤0.0001) and anxiety (P=0.006), greater knowledge of AF (P=0.01), and higher levels of physical activity (P=0.02) were associated with higher activation levels.ConclusionHigher levels of patient activation in those with AF were associated with a more positive health status and educational attainment. Additional research to describe activation in patients with AF is warranted to identify patients at risk for low activation and to tailor interventions to activation level.

Factors influencing adherence to non-vitamin K antagonist oral anticoagulants in the early period after atrial fibrillation catheter ablation in China

“…Some studies have reported that anxiety was associated with a high activation level and better medication adherence, while others drew the opposite conclusion. [ 4 , 5 ] The result of our study indicated that anxiety was beneficial to NOAC adherence. In patients with AF, anxiety mainly arises from fear of both symptoms of AF and thromboembolic events.…”

Patient-reported outcomes at hospital discharge among patients with arrhythmia: Results from the national DenHeart survey

“…Finally, we found that lower educational level is associated with worse PROs, which is in line with other studies. 38, 39 This is important knowledge, as lower socioeconomic position is known to be associated with higher cardiovascular mortality rates. 40…”

The EMPOWER-SUSTAIN e-Health Intervention to improve patient activation and self-management behaviours among individuals with Metabolic Syndrome in primary care: study protocol for a pilot randomised controlled trial

“…Previous studies have emphasised that increased patient activation level has been shown to improve self-management behaviours, such as physical activity (PA), diet and medication adherence, in patients with various chronic conditions [25,[30][31][32]. Patient activation has also been shown to improve quality of life and health outcomes and to reduce the use of health care services and costs for patients with various chronic conditions [25,[30][31][32][33]. However, there is a gap in the literature pertaining to intervention targeting to improve patient activation in patients with multiple CVD risk factors, such as MetS, especially in the younger generations.…”