Preparation for and Implementation of Shared Medical Appointments to Improve Self-Management, Knowledge, and Care Quality Among Patients With Atrial Fibrillation

Griffin, Joan M.; Stuart-Mullen, Lynette; Schmidt, Mareike; McCabe, Pamela J.; O’Byrne, Thomas J.; Branda, Megan E.; McLeod, Christopher J.

doi:10.1016/j.mayocpiqo.2018.06.003

Cited by 6 publications

(8 citation statements)

References 37 publications

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“…We conducted a secondary analysis of prospectively collected data previously obtained for an implementation project that is described elsewhere. 19 This study was approved by the Mayo Clinic Institutional Review Board and determined to be exempt because secondary analysis was performed on de-identified data and patients had provided authorization for their data to be used for research purposes.…”

Section: Methodsmentioning

confidence: 99%

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

McCabe¹,

Stuart-Mullen²,

McLeod³

et al. 2018

PPA

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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.

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Section: Methodsmentioning

confidence: 99%

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

McCabe¹,

Stuart-Mullen²,

McLeod³

et al. 2018

PPA

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“…Recent evidence underscores the potential benefits of lifestyle modifications in AF management, with a specific focus on autonomic nervous system modulation [52]. These modifications exhibit the capacity to influence arrhythmia development and AF therapy by impacting autonomic tone [53,54]. Feasibility trials have probed the effects of autonomic modulation therapy, aiming to enhance AF management [55].…”

Section: Lifestyle Modifications For Managing Atrial Fibrillationmentioning

confidence: 99%

Nonpharmacological Approach to Managing Atrial Fibrillation: A Review

Ifiora,

Agudosi,

Ekpemiro

et al. 2023

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Background: AF's global prevalence underscores its significance as a cardiac rhythm disorder that disrupts atrial activity, impairing normal cardiac function. Over five decades of study have illuminated the pathophysiological mechanisms underlying AF, including insights into re-entrant waves and macro-reentrant circuits. The emergence of non-uniform conduction patterns and bidirectional block regions has further enriched our understanding. Risk factors contributing to AF development encompass cardiovascular conditions, advanced age, and atrial structural changes. With its implications on stroke risk and cardiovascular health, AF has become a growing public health concern. The focus on AF epidemiology has expanded, with attention on the relationship between left atrial size and AF development. Individuals with larger left atria exhibit a heightened risk. Additionally, the elevated stroke risk associated with AF has been consistently documented. To optimize clinical management, distinctions are drawn between chronic and paroxysmal AF, as well as the presence of structural heart disease. Mapping techniques have revealed insights into "atrial remodeling" and AF pathology. In managing AF, controlling heart rate, preventing clot formation, and restoring sinus rhythm are principal objectives. This article categorizes AF into acute, chronic, stable, or unstable forms, tailoring management approaches accordingly. While pharmacological interventions have shown efficacy, their limitations drive the exploration of nonpharmacological strategies. Approaches range from medications to cardioversion, including electrical and pharmacological methods. Objective: This paper aimed to provide a comprehensive exploration of non-pharmacological approaches to AF management. Methodology: This paper employed a structured methodology. This method involved a literature review, data synthesis, and critical analysis. During the literature review phase, we systematically searched electronic databases (PubMed, MEDLINE, Embase, and Google Scholar) for studies published from 1960 to 2023. Specific keywords and phrases such as "atrial fibrillation," "non-pharmacological interventions," "electrical cardioversion," "catheter ablation," "lifestyle modifications," "autonomic modulation," "left atrial appendage closure," and "exercise" were used. Our inclusion criteria encompassed studies addressing various non-pharmacological approaches for AF management, including observational studies and randomized controlled trials. Result: The initial stage of our study involved the identification of a substantial number of relevant studies. We conducted a thorough literature search across multiple databases, using specific search terms and criteria relevant to our research topic. This comprehensive search yielded a total of 1,200 studies. After applying these stringent filtering criteria, we were left with 350 studies. To further refine our final sample and categorize the studies according to type, we conducted a detailed review of the remaining 350 studies. We categorized them into various types based on study design, methodology, and focus. We then also excluded studies with duplicate ideas and finally included 103 studies that addressed the objective of our research plan. (See reference list [1-103]). Conclusion: This reviewed a number of non-pharmacological approaches including electrical cardioversion, catheter ablation, lifestyle modifications, autonomic modulation, left atrial appendage closure, and exercise, the paper delves into each method's advantages, potential risks, techniques, and efficacy. By offering this extensive overview, the article contributes to the expanding repository of knowledge on non-pharmacological approaches for AF management. These approaches offer potential for unique management of atrial fibrillations or in addition to pharmacologic management, may improve patient survivability or reduce complication outcomes. In the management of Atrial fibrillation, choice between rhythm and rate control, lifestyle modifications, and patient adherence to treatment plans are critical factors influencing outcomes are factors to consider. Emerging therapies offer promise, but timely diagnosis, individualized care, and ongoing monitoring remain essential to improving AF patients' overall prognosis.

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“…17,20,96 Nurse and nurse practitioner-led AF clinics also offer the fundamental elements and structure to support greater patient involvement in treatment decision making. 87,97 Nurses’ role in SDM fits well within nursing scope of practice and professional competencies (eg, patient education, values-based decision making). Recognition of the knowledge, skills and contributions of advanced practice providers, behavioral/mental health providers, and pharmacists as key team members to facilitate quality health decision making with patients is an opportunity for enhancing multidisciplinary team SDM practices.…”

Section: Impact On Care Team Practicesmentioning

confidence: 99%

Shared Decision Making in Cardiac Electrophysiology Procedures and Arrhythmia Management

Chung

Fagerlin

Wang

et al. 2021

Circ: Arrhythmia and Electrophysiology

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Shared decision-making (SDM) has been advocated to improve patient care, patient decision acceptance, patient-provider communication, patient motivation, adherence, and patient reported outcomes. Documentation of SDM is endorsed in several society guidelines and is a condition of reimbursement for selected cardiovascular and cardiac arrhythmia procedures. However, many clinicians argue that SDM already occurs with clinical encounter discussions or the process of obtaining informed consent and note the additional imposed workload of using and documenting decision aids without validated tools or evidence that they improve clinical outcomes. In reality, SDM is a process and can be done without decision tools, although the process may be variable. Also, SDM advocates counter that the low-risk process of SDM need not be held to the high bar of demonstrating clinical benefit and that increasing the quality of decision-making should be sufficient. Our review leverages a multidisciplinary group of experts in cardiology, cardiac electrophysiology, epidemiology, and SDM, as well as a patient advocate. Our goal is to examine and assess SDM methodology, tools, and available evidence on outcomes in patients with heart rhythm disorders to help determine the value of SDM, assess its possible impact on electrophysiological procedures and cardiac arrhythmia management, better inform regulatory requirements, and identify gaps in knowledge and future needs.

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Preparation for and Implementation of Shared Medical Appointments to Improve Self-Management, Knowledge, and Care Quality Among Patients With Atrial Fibrillation

Cited by 6 publications

References 37 publications

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

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

Nonpharmacological Approach to Managing Atrial Fibrillation: A Review

Shared Decision Making in Cardiac Electrophysiology Procedures and Arrhythmia Management

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