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Lapa ME, Swabe GM, Magnani JW. Association of Depression and Adherence to Oral Anticoagulation in Patients With Atrial Fibrillation. J Am Heart Assoc 2023; 12:e031281. [PMID: 37982265 PMCID: PMC10727299 DOI: 10.1161/jaha.123.031281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/25/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Adherence to oral anticoagulation is essential for stroke prevention in atrial fibrillation (AF). Depression has been associated with decreased adherence to medications in multiple disease states and in AF is further associated with increased risk of stroke. We hypothesized that individuals with depression and AF have decreased adherence to anticoagulation than those without depression. METHODS AND RESULTS We used administrative claims data to identify individuals with AF initiating anticoagulation with direct-acting oral anticoagulants (DOACs) or warfarin between 2013 and 2019. We quantified adherence using proportion of days covered, categorized as limited (proportion of days covered, <80%), adequate (proportion of days covered, ≥80% to <90%), or optimal (proportion of days covered, ≥90%). We related depression to 12-month adherence to anticoagulation in logistic regression models, adjusting for demographics, medical and psychiatric comorbidities, household income, educational attainment, and insurance type. As a secondary analysis, we determined the association of depression to adherence for each DOAC agent. We identified 101 041 individuals (aged 74.5±8.9 years; 50.6% women; 29.5% race or ethnicity other than White, including Asian or Black race and Hispanic ethnicity) who initiated either DOACs or warfarin. The odds of adequate adherence to DOACs was 11% (95% CI, 0.85-0.93), and the odds of optimal adherence was 12% (95% CI, 0.83-0.91) less in individuals with depression than those without. Depression was not associated with adherence to warfarin. CONCLUSIONS We identified an association between depression and decreased adherence to DOACs but not warfarin in individuals with AF. Recognizing depression in AF may guide interventions to improve anticoagulation adherence and reduce stroke risk.
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Affiliation(s)
| | | | - Jared W. Magnani
- Department of MedicineUniversity of PittsburghPittsburghPA
- Center for Research on Health Care, Department of MedicineUniversity of PittsburghPittsburghUSA
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Manolis TA, Manolis AA, Apostolopoulos EJ, Melita H, Manolis AS. Depression and atrial fibrillation in a reciprocal liaison: a neuro-cardiac link. Int J Psychiatry Clin Pract 2023; 27:397-415. [PMID: 37615537 DOI: 10.1080/13651501.2023.2248214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/09/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE To explore the reciprocal relationship of depression and atrial fibrillation (AF). METHODS A literature search was conducted in Pub Med, Scopus, and Google Scholar using relevant terms for depression and AF and respective therapies. RESULTS There is evidence that depression is involved in the aetiology and prognosis of AF. AF, independently of its type, incurs a risk of depression in 20-40% of patients. Also, depression significantly increases cumulative incidence of AF (from 1.92% to 4.44% at 10 years); 25% increased risk of new-onset AF is reported in patients with depression, reaching 32% in recurrent depression. Hence, emphasis is put on the importance of assessing depression in the evaluation of AF and vice versa. Persistent vs paroxysmal AF patients may suffer from more severe depression. Furthermore, depression can impact the effectiveness of AF treatments, including pharmacotherapy, anticoagulation, cardioversion and catheter ablation. CONCLUSIONS A reciprocal association of depression and AF, a neurocardiac link, has been suggested. Thus, strategies which can reduce depression may improve AF patients' course and treatment outcomes. Also, AF has a significant impact on risk of depression and quality of life. Hence, effective antiarrhythmic therapies may alleviate patients' depressive symptoms. KEY POINTSAF, independently of its type of paroxysmal, permanent or chronic, appears to have mental besides physical consequences, including depression and anxietyA reciprocal influence or bidirectional association of depression and AF, a neurocardiac link, has been suggestedAF has considerable impact on the risk of depression occurrence with 20-40% of patients with AF found to have high levels of depressionAlso, depression significantly increases 10-year cumulative incidence and risk of AF from 1.92% to 4.44% in people without depression, and the risk of new-onset AF by 25-32%Emphasis should be placed on the importance of assessing depression in the evaluation of AF and vice versaPersistent/chronic AF patients may suffer from more severe depressed mood than paroxysmal AF patients with similar symptom burdenDepression and anxiety can impact the effectiveness of certain AF treatments, including pharmacotherapy, anticoagulation treatment, cardioversion and catheter ablationThus, strategies which can reduce anxiety and depression may improve AF patients' course and treatment outcomesAlso, effective antiarrhythmic therapies to control AF may alleviate patients' depressive mood.
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3
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Wang L, Ding C. Major depression disorder may causally associate with the increased atrial fibrillation risk: evidence from two-sample mendelian randomization analyses. BMC Med Genomics 2023; 16:144. [PMID: 37353760 PMCID: PMC10288724 DOI: 10.1186/s12920-023-01565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/31/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Observational studies have revealed a link between major depressive disorder (MDD) and a higher chance of developing atrial fibrillation (AF). It is still uncertain whether or not this correlation indicates a causal relationship. This research set out to evaluate the causal impact of MDD on AF. METHODS To evaluate the causal relationship between MDD and AF, we employed a two-sample Mendelian randomization (MR) method. A new genome-wide association study (GWAS) with 500,199 participants was used to obtain an overview of the association of genetic variations with MDD. An additional GWAS incorporating 1,030,836 people provided data on the relationship between gene variants and AF. The inverse-variance weighted technique was utilized to assess the effect sizes. Sensitivity analysis included the use of other statistical approaches such as weighted median, Outlier, MR Pleiotropy Residual Sum, weighted mode, simple mode, and MR - Egger. RESULTS By employing 47 single nucleotide polymorphisms (SNPs) as markers, MR analyses in random-effect inverse-variance weighted models found that genetically projected MDD was linked to an elevated incidence of AF (odds ratio [OR] = 1.098, 95% CI 1.000-1.206; P = 0.049). No gene pleiotropy was discovered as indicated by MR-Egger (intercept= -0.011, P = 0.169). Sensitivity analysis employing other MR techniques yielded reliable results. CONCLUSION This MR study established a causal relationship between genetically predicted MDD and an elevated risk of AF.
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Affiliation(s)
- Lei Wang
- Cardiac Department, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, PR China
| | - Chunhua Ding
- Cardiac Department, Aerospace Center Hospital, 15 Yuquan Road, Haidian District, Beijing, 100049, PR China.
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4
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Rosenstrøm S, Risom SS, Kallemose T, Dixen U, Hove JD, Brødsgaard A. Clinical outcomes of a short-term family-focused intervention for patients with atrial fibrillation-A randomised clinical trial. PLoS One 2023; 18:e0282639. [PMID: 36928447 PMCID: PMC10019651 DOI: 10.1371/journal.pone.0282639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 02/16/2023] [Indexed: 03/18/2023] Open
Abstract
AIMS To evaluate a family-focused intervention for patients with atrial fibrillation (AF) in addition to conventional care and to establish its effect on health-related quality of life (HRQoL), anxiety, depression, AF symptoms, and family support. BACKGROUND AF is a widespread heart disease affecting the well-being of patients and their family members physically and psychologically. Supporting patients and their family members could potentially facilitate regaining family strength and improve HRQoL. METHODS Patients with newly diagnosed AF were randomised to standard care or additional family-focused intervention with change in global score of the Atrial Fibrillation Quality of Life Questionnaire (AFEQT) as primary outcome after six months' follow-up. Secondary outcomes included the Hospital Anxiety and Depression Score, the European Heart Rhythm Association score, the Ice Expressive Family Functioning Questionnaire, and the Ice Family-Perceived Support Questionnaire (ICE-FPSQ). RESULTS Sixty-eight patients received standard care (n = 35) or family focused intervention (n = 33). The median change at the six-month follow-up on the global AFEQT score was 4.17 (-1.46-9.17) in the control group and 5.83 (-2.5-30) in the intervention group, yielding a median difference of -1.67 (p = 0.500). Change in ICE-FPSQ showed significant positive scores in favour of intervention (p < 0.001); other secondary outcome changes were non-significant. CONCLUSION The family-focused intervention had a small positive but non-significant effect on HRQoL compared to standard care. To address the impact of AF on the patients and family members seems to improve anxiety and depression scores and perceived family support.
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Affiliation(s)
- Stine Rosenstrøm
- Department of Cardiology, Copenhagen University Hospital, Amager Hvidovre, Capital Region of Denmark
- Nursing and Health Care, Department of Public Health, University of Aarhus, Aarhus, Denmark
- * E-mail:
| | - Signe Stelling Risom
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
- Institute of Nursing and Nutrition, University College, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital, Amager Hvidovre, Capital Region of Denmark
| | - Ulrik Dixen
- Department of Cardiology, Copenhagen University Hospital, Amager Hvidovre, Capital Region of Denmark
- Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens Dahlgaard Hove
- Department of Cardiology, Copenhagen University Hospital, Amager Hvidovre, Capital Region of Denmark
- Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Brødsgaard
- Nursing and Health Care, Department of Public Health, University of Aarhus, Aarhus, Denmark
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Amager Hvidovre, Capital Region of Denmark
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Amager Hvidovre, Capital Region of Denmark
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5
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Blomström-Lundqvist C, Svedung Wettervik V. Reflections on the usefulness of today's atrial fibrillation ablation procedure endpoints and patient-reported outcomes. Europace 2022; 24:ii29-ii43. [PMID: 35661867 DOI: 10.1093/europace/euab318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
The improvement of Patient-reported outcomes, such as health-related quality of life, is the main indication for atrial fibrillation ablation. Despite this guideline derived indication for an AF ablation procedure the current standardized primary endpoint in AF ablation trials is still rhythm-related, and primarily a 30-second long AF episode. The review presents reflections on the non-rational arguments of using rhythm related endpoints rather than Patient-reported outcomes in AF ablation procedure trials despite the mismatch between many of the rhythm related variables and symptoms. Arguments for health-related quality of life as the most optimal primary endpoint in clinical trials are presented while atrial fibrillation burden is presented as the most optimal electrical complementary endpoint, apart from being the major variable in mechanistic trials.
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6
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Li S, Li Q, Jiang C, Chen X, Lai Y, He L, Cui F, Wu J, Hu R, Jia C, Feng L, Sang C, Tang R, Long D, Du X, Dong J, Ma C. Factors associated with depression and anxiety among caregivers of patients with atrial fibrillation. J Clin Nurs 2021; 31:3263-3271. [PMID: 34866264 DOI: 10.1111/jocn.16165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To assess the prevalence and associated factors of depression and anxiety among caregivers of patients with atrial fibrillation. BACKGROUND Depression and anxiety are common in caregivers of patients with cardiovascular diseases, including heart failure and coronary artery disease. However, studies about depression and anxiety among caregivers of patients with atrial fibrillation are limited. DESIGN Cross-sectional study. METHODS We enrolled 465 dyads of patients with atrial fibrillation and their primary family caregivers from Beijing Anzhen Hospital between September 2020 and March 2021. The patient-caregiver dyads were excluded if primary family caregivers had previous mental disorders before the patient diagnosis of atrial fibrillation. Depression and anxiety of patients and caregivers were measured by Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scale. Multivariate logistic regression analysis was used to assess factors associated with depression and anxiety of caregivers. STROBE guidelines were followed to report this study. RESULTS The prevalence of caregiver depression (Patient Health Questionnaire-9 score ≥5) and anxiety (Generalized Anxiety Disorder-7 score ≥5) was 14.0% and 13.5% respectively. Caregiver number of comorbidities ≥2 and patient depression were significantly associated with caregiver depression. Caregiver age ≥65 years, caregiver female sex and patient anxiety were predictors of caregiver anxiety. CONCLUSIONS Depression and anxiety are common in caregivers of patients with AF. Better management of caregiver mental problems and associated factors may benefit both patients and caregivers. RELEVANCE TO CLINICAL PRACTICE Clinicians and nurses should pay more attention to depression and anxiety in caregivers of patients with atrial fibrillation, and provide support to caregivers in most need.
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Affiliation(s)
- Sitong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Qifan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xuan Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Feihuan Cui
- Department of Psychology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiahui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Rong Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Changqi Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Li Feng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.,Heart Health Research Center, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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7
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Silva RL, Guhl EN, Althouse AD, Herbert B, Sharbaugh M, Essien UR, Hausmann LRM, Magnani JW. Sex differences in atrial fibrillation: patient-reported outcomes and the persistent toll on women. Am J Prev Cardiol 2021; 8:100252. [PMID: 34541565 PMCID: PMC8435986 DOI: 10.1016/j.ajpc.2021.100252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/23/2021] [Accepted: 08/31/2021] [Indexed: 11/08/2022] Open
Abstract
Patient-reported outcomes (PRO) in atrial fibrillation (AF) differ by sex. We compared general and disease-specific PRO in women and men with AF. Comorbidity, treatment, and social factors did not change differences. Modification of such factors by sex also did not change differences in PRO. Sex-specific assessment of PRO is essential to improve how women experience AF.
Background Women have worse patient-reported outcomes in atrial fibrillation (AF) than men, but the reasons remain poorly understood. We investigated how comorbid conditions, treatment, social factors, and their modification by sex would attenuate sex-specific differences in patient-reported outcomes in AF. Methods In a cohort with prevalent AF we measured patient-reported outcomes with the Short-Form-12 (SF-12, an 8-domain quality of life measure), and the AF Effect on QualiTy of Life (AFEQT), an instrument specific to AF, both with range 0-100 and higher scores indicating superior outcomes. We examined sex-specific differences in patient-reported outcomes in multivariable-adjusted regression analyses incorporating demographics, comorbid conditions, treatment, social factors, and their sex-based modification. Results In 339 individuals (age 72±10, 45% women), women (vs. men) reported worse physical functioning on the SF-12 (49.7±39.0 versus 65.0±34.0), social functioning (69.8±31.8 versus 79.7±25.8), and mental health (67.4±20.2 versus 75.0±18.6). These differences were attenuated with adjustment for comorbid conditions and depression. Women had worse composite AFEQT scores (73.8±18.4 versus 78.5±16.6) and symptoms and treatment scores than men with differences remaining significant after multivariable adjustment. There were not significant interactions by sex and the array of covariates when examining differences in patient-reported outcomes between women and men. Conclusions We identified sex-specific differences in patient-reported outcomes assessed with general and AF-specific measures. Compared to men, women with AF reported worse overall health-related quality of life, even after consideration of both relevant covariates and their modification by sex. Our research indicates the importance of consideration of sex-based inequities when evaluating patient-reported outcomes in AF.
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Affiliation(s)
- Raisa L Silva
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, US
| | - Emily N Guhl
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, US
| | - Andrew D Althouse
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, US
| | - Brandon Herbert
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, US
| | - Michael Sharbaugh
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, US
| | - Utibe R Essien
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, US.,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, US
| | - Leslie R M Hausmann
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, US.,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, US
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, US.,Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, US.,Center for Research on Health Care, University of Pittsburgh, Department of Medicine, Pittsburgh, PA, US
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8
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Tertulien T, Chen Y, Althouse AD, Essien UR, Johnson A, Magnani JW. Association of income and educational attainment in hospitalization events in atrial fibrillation. Am J Prev Cardiol 2021; 7:100201. [PMID: 34611640 PMCID: PMC8387303 DOI: 10.1016/j.ajpc.2021.100201] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Social determinants contribute to adverse outcomes in cardiovascular and non-cardiovascular conditions. However, their investigation in atrial fibrillation (AF) remains limited. We examined the associations between annual income and educational attainment with risk of hospitalization in individuals with AF receiving care in a regional health care system. We hypothesized that individuals with lower income and lower education would have an increased risk of hospitalization. METHODS We enrolled a cohort of individuals with prevalent AF from an ambulatory setting. We related annual income (≤$19,999/year; $20,000-49,000/year; $50,000-99,999/year; ≥$100,000/year) and educational attainment (high school/vocational; some college; Bachelor's; graduate) to hospitalization events in multivariable-adjusted Cox proportional hazards models, using the Andersen-Gill model to account for the potential of participants to have multiple events. RESULTS In 339 individuals with AF (age 72.3 ± 10.1 years; 43% women) followed for median 2.6 years (range 0-3.4 years), we observed 417 hospitalization events. We identified an association between both income and educational attainment and hospitalization risk. In multivariable-adjusted analyses which included educational attainment individuals in the lowest annual income category (≤19,999/year) had 2.0-fold greater hospitalization risk than those in the highest (≥100,000/year; 95% Confidence Interval [CI] 1.08-4.09; p = 0.03). In multivariable-adjusted analyses without adjustment for income, those in the lowest educational attainment category (high school/vocational) had a 2-fold increased risk of hospitalization relative to the highest (graduate-level; 95% CI 1.12-3.54, p = 0.02). However, this association between education and events was attenuated with further adjustment for income (95% CI 0.97-3.15, p = 0.06). CONCLUSIONS We identified relationships between income and education and prospective risk of hospitalization risk in AF. Our findings support the consideration of social determinants in evaluating and treating socioeconomically disadvantaged individuals with AF to reduce hospitalization risk.
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Affiliation(s)
- Tarryn Tertulien
- Department of Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, United States
| | - Yimin Chen
- Department of Medicine, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, United States
| | - Andrew D. Althouse
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Utibe R. Essien
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Amber Johnson
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh PA, United States
| | - Jared W. Magnani
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh PA, United States
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9
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Chang SL, Kuo MJ, Lin YJ, Chen SA, Chen CT, Yang YY, Yang LY, Kao SY, Shulruf B, Lee FY. Virtual reality-based preprocedural education increases preparedness and satisfaction of patients about the catheter ablation of atrial fibrillation. J Chin Med Assoc 2021; 84:690-697. [PMID: 34029219 DOI: 10.1097/jcma.0000000000000555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A recent study suggested to develop and implement more interacted material for preprocedural education to decrease patients' anxiety about the atrial fibrillation (AF) ablation. This study compared the effectiveness of using either newly developed virtual reality (VR) materials (VR group) or paper-based materials (paper group) on giving AF preprocedural education. METHODS This study consequentially enrolled 33 AF patients preparing for ablation from November 2019 to October 2020. After enrollment, patients were randomized as either paper (n = 22) or VR (n = 11) groups. RESULTS In comparison with the baseline stage, at the posteducation stage, the degree of improvement in patients' self-assessed self-efficacy on AF ablation knowledge was higher among VR group patients than those in the paper group. At the posteducation stage, the patients' satisfaction to preprocedural education and used materials were higher among the VR group than that among the paper group. In addition to meet their needs and give accurate medical information, VR group patients reported that VR materials increased the effectiveness of education, increased their preparedness for AF catheter ablation, achieved paperless purposes, and willing to recommend VR materials to others. Operators subjectively reported that the periprocedure cooperation was increased both among paper and VR group patients after preprocedural education for the details of procedure. Better preparedness of VR group patients was supported by less periprocedure pain, anxiety, and impatience than those among paper group patients. CONCLUSION Interactive VR-based materials are superior to the paper-based materials to provide patients immerse and imagine the journey and detail knowledge of AF catheter ablation before the procedure and better prepared patients for the procedure.
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Affiliation(s)
- Shih-Lin Chang
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Jen Kuo
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chung-Ting Chen
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ying-Ying Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Yu Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shou-Yen Kao
- Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | | | - Fa-Yauh Lee
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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10
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Association of patient-reported outcomes with hospitalization risk in atrial fibrillation. ACTA ACUST UNITED AC 2021; 2. [PMID: 34151309 PMCID: PMC8211119 DOI: 10.1016/j.ahjo.2021.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Patient-reported outcomes in atrial fibrillation (AF) are increasingly used to evaluate treatment efficacy and as endpoints in clinical trials. Few studies have related patient-reported outcomes in AF to clinical events and outcomes. We examined the association between patient-reported outcomes and hospitalization risk in individuals with AF receiving care at a regional healthcare system. Methods and results We related the AF Effect on QualiTy of Life (AFEQT), a validated measure (range 0-100) with higher scores indicating superior AF-specific patient-reported outcomes, to hospitalization events in a cohort with prevalent AF. We determined incidence rates for hospitalization events (all-cause, cardiac-, or AF-related) across quartiles of AFEQT scores. We used the Andersen-Gill method to account for multiple hospitalization events per individual and compared the risks of hospitalization across AFEQT quartiles in multivariable-adjusted models. In 339 individuals with AF (age 72.3 ± 10.1 years; 43% women) followed for median 2.6 years (range 0-3.4 years), we observed 417 total hospitalization events. We identified increased incidence rates of hospitalization with progressively decreased AFEQT quartile. Relative to those in the highest AFEQT quartile, individuals in the lowest AFEQT quartile had 3-fold greater risk of all-cause hospitalization (95% Confidence Interval [CI] 1.67-6.57, p < 0.001) and 5-fold greater risk of cardiac hospitalization (95% CI 1.66-13.80, p = 0.004). Conclusions We identified a progressive association between patient-reported outcomes in AF and risk of hospitalization events. Our results underscore the relevance of patient-reported outcomes to clinical adversity and prognosis in AF.
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Chang SL, Kuo MJ, Lin YJ, Chen SA, Yang YY, Cheng HM, Yang LY, Kao SY, Lee FY. Virtual reality informative aids increase residents' atrial fibrillation ablation procedures-related knowledge and patients' satisfaction. J Chin Med Assoc 2021; 84:25-32. [PMID: 33230060 DOI: 10.1097/jcma.0000000000000464] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia, and increasing numbers of patients receive AF ablation nowadays. Therefore, in the cardiology division, residents need to be familiar with the AF ablation procedure-related knowledge for primary care. This study evaluated the baseline residents and patients' self-efficacy to the AF ablation procedure-related knowledge, developed the specific virtual reality (VR) informative aids, and evaluated the effects of VR training and resident-led VR aids-based patient education on their self-efficacy, in the aspects of familiarity, confidence and anxiety, and satisfaction. METHODS From 2019, April to 2020, April, this 1-year prospective prestudy and poststudy was undergone in the cardiology division. Between 2019, April and 2019, December, the experienced physicians were invited to develop VR informative aids for AF ablation procedure-related knowledge. Between January 2020 and April 2020, newly developed VR informative aids were implemented in the educational program of training rotated residents for giving patient education. RESULT A total of 20 residents and 32 patients were enrolled. The baseline self-reported self-efficacy and knowledge scores were relatively low among rotated residents and their patients. In addition to the high level of satisfaction, self-efficacy and knowledge scores of residents and their patients were increased after VR aids-based training and resident-led patient education. Higher degree of improvement in self-efficacy was noted among patients with depression/anxiety history than those without history. The follow-up assessments among residents showed that the positive effects of VR aids were sustained until 2 weeks later. CONCLUSION Overall, residents and patients reported that the VR aids increase the effectiveness of patient education, achieve the purpose of a paperless environment, and motivate them to recommend it to others. The implementation of resident-to-patient education has a positive impact on trainees and patients understanding about AF ablation procedures-related knowledge.
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Affiliation(s)
- Shih-Lin Chang
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ming-Jen Kuo
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yenn-Jiang Lin
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shih-Ann Chen
- Vice Superintendent, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ying-Ying Yang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hao-Min Cheng
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Yu Yang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shou-Yen Kao
- Vice Superintendent, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Vice Superintendent, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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12
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Sears SF, Anthony S, Naniwadekar A. Modern atrial fibrillation care: Becoming a pro at using PROs. J Cardiovasc Electrophysiol 2020; 31:3196-3198. [PMID: 33118655 DOI: 10.1111/jce.14793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA.,Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Scarlett Anthony
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Aditi Naniwadekar
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
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Hynes M. Beyond Ablation in Atrial Fibrillation: 10 Steps to Better Control. Am J Lifestyle Med 2020; 15:434-440. [PMID: 34366742 DOI: 10.1177/1559827620943326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The prevention and treatment of atrial fibrillation includes risk factor modification beyond ablation, with lifestyle modifications including treatment of obesity through diet and moderate exercise being at the top of the list. Losing 10% of body weight if obese, a plant-based diet, exercise, maintaining systolic blood pressure below 130 mm Hg, treatment of sleep disorders and obstructive sleep apnea, stress management, and treatment of depression and anxiety should all be included in treatment. Maximizing evidence-based treatment of chronic obstructive pulmonary disease and diabetes is also paramount.
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Affiliation(s)
- Marijane Hynes
- School of Medicine and Health Sciences, The George Washington University, Washington, DC
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