Atrial fibrillation: treatment rationale and clinical utility of nonpharmacologic therapies

Atrial fibrillation among older adults: pathophysiology, symptoms, and treatment

Atrial fibrillation is the most common arrhythmia among older adults. Valvular heart disease, dilated cardiomyopathy, aortic stenosis, hypertension, coronary artery disease, pericarditis, thyrotoxicosis, pulmonary disease, cardiac surgery, alcohol excess, and alcohol withdrawal are associated with atrial fibrillation. Nurses caring for older adults need to understand the condition's pathophysiology, signs and symptoms, diagnostic data and treatment protocols, and adherence issues to prevent the formation of emboli in chronic atrial fibrillation and to understand treatment of this common arrhythmia. This article presents an individual example of an elderly man exhibiting a new onset of atrial fibrillation and the interventions required to manage the associated complications. Atrial fibrillation places patients at risk for stroke from a thromboembolism; thus, pharmacological and nonpharmocological care strategies for managing patients with atrial fibrillation are discussed.

Atrial fibrillation: public health implications

BACKGROUND

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the United States, affecting 2.3 million Americans. AF is associated with significant morbidity, mortality, and poor quality of life. AF and its treatments result in high healthcare resource use and costs.

OBJECTIVE

To develop a framework for public health action for the prevention, detection, and control of AF.

METHODS

A literature search was conducted via MEDLINE and CINAHL for the 1990-2004 period. Key words included atrial fibrillation, epidemiology, prevention, detection, treatment, and public health.

RESULTS

Published data predict a substantial increase in the prevalence of AF due to improved survival of people with coronary heart disease; increasing prevalence of hypertension, heart failure, and diabetes; and the aging of the American population. Low public awareness of AF and quality-of-care issues related to detection, control, and management are evident.

CONCLUSIONS

Awareness, early detection and treatment, improved patient self-management, and attention by public health programs are essential to reduce the burden of AF. Partnerships among professional nursing and medical organizations, the Centers for Disease Control and Prevention, and patient advocacy groups represent another important approach to improving public health outcomes for AF. Hospitalizations for AF and controversies over optimal treatment strategies (e.g., rate vs rhythm control) underscore the need for both public health and applied research.

Non-valvular atrial fibrillation and stroke: Implications for nursing practice and therapeutics

Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance and is increasing in prevalence due to the ageing of the population, and rates of chronic heart failure. Haemodynamic compromise and thromboembolic events are responsible for significant morbidity and mortality in Australian communities. Non-valvular AF is a significant predictor for both a higher incidence of stroke and increased mortality. Stroke affects approximately 40,000 Australians every year and is Australia's third largest killer after cancer and heart disease. The burden of illness associated with AF, the potential to decrease the risk of stroke and other embolic events by thromboprophylaxis and the implications of this strategy for nursing care and patient education, determine AF as a critical element of nursing practice and research. A review of the literature was undertaken of the CINAHL, Medline, EMBASE and Cochrane Databases from 1966 until September 2002 focussing on management of atrial fibrillation to prevent thrombotic events. This review article presents key elements of this literature review and the implications for nursing practice.

Atrial fibrillation: the newest frontier in arrhythmia management

At least 2.3 million people in the United States have atrial fibrillation. Since the risk for developing atrial fibrillation increases with age, the number of people with atrial fibrillation is expected to rise sharply. Atrial fibrillation is a complex condition that adversely influences mortality, morbidity, quality of life, and use of health care resources. Knowledge generated from extensive research has led to innovative management strategies. As the number of individuals with atrial fibrillation increases and treatment options expand, nurses in a variety of settings will be challenged to respond to the multifaceted needs of this population. This review discusses the significance of atrial fibrillation and summarizes research findings influencing current management strategies. Pharmacologic therapies are reviewed and new technologies for atrial fibrillation treatment are introduced. Nursing assessment and treatment of patients' response to atrial fibrillation are discussed. Recommendations for patient education are offered. A plan describing specific nursing diagnoses, outcomes, interventions, and activities for care of patients with atrial fibrillation is presented.

The significance of atrial fibrillation ablation in patients undergoing mitral valve surgery

Atrial fibrillation is present in close to 50% of all patients undergoing surgery for mitral valve disease.(1-3) However, surgical correction of atrial fibrillation in patients with other cardiac pathology that requires surgical intervention such as mitral valve disease was never considered as a standard approach. The Maze procedure for the treatment of atrial fibrillation was introduced in 1987 and was performed safely in hundreds of patients with excellent outcomes.(4-7) As a result, several centers have begun to combine the Maze procedure with other cardiac procedures, especially mitral valve surgery, without adding undue operative risk to patients.(8) When properly performed, the results with this combined approach have been excellent.(9,10)

Antidysrhythmic agents at the turn of the twenty-first century: a current review

The use of class IA agents is gradually on the decline, primarily as a result of its unfavorable risk-to-benefit ratio. Lidocaine, a class IB agent, has been widely used in the acute treatment of VT. However, alternate drugs are being considered increasingly as first-line agents in the acute treatment of VT. Class IC drugs are contraindicated in patients with structural cardiac abnormalities and have a limited usefulness in the management of dysrhythmias. Beta-blockers continue to increase their role in cardiology, and subsequently their use in managing dysrhythmias. Class III agents, including amiodarone, sotalol, ibutilide, and dofetilide, are among the most widely used antidysrhythmics. Class IV calcium channel blockers have a limited usefulness in tachydysrhythmias. Digoxin and adenosine have unique antidysrhythmic properties and will likely retain their roles as antidysrhythmic agents. In the wake of the effectiveness of amiodarone, the drug that crosses all classes, some now question the benefit of pure agents that block a single, specific ion channel in the heart. After CAST8 demonstrated that antidysrhythmics can increase mortality while seemingly suppressing dysrhythmias, new drugs will continue to undergo intense scrutiny with regard to their efficacy, safety, and usefulness in treating dysrhythmias.