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Tian M, Kang J, Huan X, Yin J, Zhang Z. Correlation between family function and quality of life in patients with atrial fibrillation. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:1234-1242. [PMID: 37875364 PMCID: PMC10930848 DOI: 10.11817/j.issn.1672-7347.2023.220551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Indexed: 10/26/2023]
Abstract
OBJECTIVES Many studies have shown that the quality of life for patients with atrial fibrillation (AF) is significantly impaired, but the impact on family function is still unclear. This study aims to evaluate the family function and quality of life in patients with AF using scales, to analyze the correlation between family function and quality of life, and to predict the influencing factors of quality of life. METHODS A total of 223 patients with AF who were admitted to the Department of Cardiology and General Medicine of the Lanzhou University Second Hospital from January 1, 2021 to May 1, 2022, were selected as research subjects, the general information of patients with AF were collected via a questionnaire, the family function and quality of life were assessed by the Family Assessment Device (FAD) and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) scale. The patients were divided into a non-family functional disorder group and a family functional disorder group on the basis of their FAD scores. The above data were analyzed using SPSS 26.0 statistical software. RESULTS Among the 223 patients, 64 (28.70%) were in the non-family functional disorder group, and 159 (71.30%) were in the family functional disorder group. The total score of FAD and scores of all dimensions in the family functional disorder group were higher than those in the non-family functional disorder group (all P<0.01). AFEQT total score and symptoms, treatment concerns and daily activities in the non-family functional disorder group were significantly higher than those in the family functional disorder group (all P<0.01). The Pearson linear analysis showed that there was a linear negative correlation between the total score and each dimension of FAD with the total score and each dimension of AFEQT (all P<0.01). The variables with statistical significance in the univariate analysis were included in the multiple linear regression analysis, and the result showed that female, and the problem solving, role, affective involvement, and general functioning dimensions of family function had an impact on the quality of life (all P<0.01). CONCLUSIONS Most patients with AF have different degrees of family dysfunction. The quality of life in patients with family functional disorder group is generally low. Female, and the problem solving, role, affective involvement, and general functioning of family function have a significant impact on the quality of life in patients with AF. In clinical treatment of AF, attention should be paid to the family function of patients, and family members can be involved in clinical intervention to improve family function and improve the quality of life.
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Affiliation(s)
- Meixiang Tian
- Department of General Medicine, Lanzhou University Second Hospital, Lanzhou 730030.
- Medical and Health Center Hospital in Kangle County, Linxia Hui Autonomous Prefecture, Gansu Province, Kangle Gansu 731500, China.
| | - Jing Kang
- Department of General Medicine, Lanzhou University Second Hospital, Lanzhou 730030
| | - Xuan Huan
- Department of General Medicine, Lanzhou University Second Hospital, Lanzhou 730030
| | - Jiangyan Yin
- Department of General Medicine, Lanzhou University Second Hospital, Lanzhou 730030
| | - Zhengyi Zhang
- Department of General Medicine, Lanzhou University Second Hospital, Lanzhou 730030.
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Berte B, Kobza R, Toggweiler S, Schüpfer G, Duytschaever M, Hoop V, Lehnick D, Santangeli P, Pürerfellner H. Improved Procedural Efficiency of Atrial Fibrillation Ablation Using a Dedicated Ablation Protocol and Lean Management. JACC Clin Electrophysiol 2020; 7:321-332. [PMID: 33632635 DOI: 10.1016/j.jacep.2020.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES In this study the authors hypothesized that "Lean management" within a dedicated ablation protocol could standardize the pulmonary vein isolation (PVI) procedure and improve quality. BACKGROUND There is a large variability in safety, effectiveness, and efficiency of PVI. METHODS This was a single-center prospective study with inclusion of all consecutive PVI procedures from 2017 to 2019. A 3-step intervention was introduced based on Lean management: step 1) simplification (CLOSE protocol); step 2) waste elimination (higher power shorter duration); and step 3) improved standardization (Lab Optimization Tool [LOT]). PVI was divided into steps that were tracked (in minutes) using LOT. Parameters were compared in 6-month intervals. RESULTS Overall, 295 patients (146 patients with LOT) were analyzed. Step 1 reduced skin-to-skin procedure duration (2017: 119 ± 21 min vs. 2018: 77 ± 15 min; p < 0.001) and variance (from 2018 to 2019 p = 0.024). Step 2 reduced the radiofrequency time (2017: 38 ± 6 min vs. 2018: 20 ± 3 min; p < 0.001) and variance (from 2018 to 2019 p < 0.001). Analysis of step 3 demonstrated that only 53% of the entire procedure length (143 ± 22 min) was used for treatment (skin-to-skin time 77 ± 16 min), the remaining time being devoted for setup (42 ± 12 min, 29%); left atrial access (16 ± 7 min, 12%); respiratory gating, left atrial map, and pseudo-circle annotation (10 ± 6 min, 7%); ablation (39 ± 10 min, 27%); and bilateral block validation (10 ± 8 min, 7%). CONCLUSIONS Standardization of PVI using a dedicated ablation protocol and Lean management can help to reduce procedure and radiofrequency ablation duration and variance, and increase procedural efficiency without compromising safety. To improve health care utilization, increased efficiency should become an accepted goal in addition to procedural safety and effectiveness.
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Affiliation(s)
- Benjamin Berte
- Heart Centre and Management, Luzerner Kantonsspital, Luzern, Switzerland; Health Economics, London School of Economics, London, United Kingdom.
| | - Richard Kobza
- Heart Centre and Management, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefan Toggweiler
- Heart Centre and Management, Luzerner Kantonsspital, Luzern, Switzerland
| | - Guido Schüpfer
- Heart Centre and Management, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Vanessa Hoop
- Clinical Support, Biosense Webster, Johnson and Johnson, Zug, Switzerland
| | - Dirk Lehnick
- Center for Biostatistics and Methodology CTU, Lucerne University, Lucerne, Switzerland
| | - Pasquale Santangeli
- Cardiology Department, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Hung M, Hon ES, Lauren E, Xu J, Judd G, Su W. Machine Learning Approach to Predict Risk of 90-Day Hospital Readmissions in Patients With Atrial Fibrillation: Implications for Quality Improvement in Healthcare. Health Serv Res Manag Epidemiol 2020; 7:2333392820961887. [PMID: 33088848 PMCID: PMC7545784 DOI: 10.1177/2333392820961887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Atrial fibrillation (AF) in the elderly population is projected to increase over the next several decades. Catheter ablation shows promise as a treatment option and is becoming increasingly available. We examined 90-day hospital readmission for AF patients undergoing catheter ablation and utilized machine learning methods to explore the risk factors associated with these readmission trends. Methods: Data from the 2013 Nationwide Readmissions Database on AF cases were used to predict 90-day readmissions for AF with catheter ablation. Multiple machine learning methods such as k-Nearest Neighbors, Decision Tree, and Support Vector Machine were employed to determine variable importance and build risk prediction models. Accuracy, precision, sensitivity, specificity, and area under the curve were compared for each model. Results: The 90-day hospital readmission rate was 17.6%; the average age of the patients was 64.9 years; 62.9% of patients were male. Important variables in predicting 90-day hospital readmissions in patients with AF undergoing catheter ablation included the age of the patient, number of diagnoses on the patient’s record, and the total number of discharges from a hospital. The k-Nearest Neighbor had the best performance with a prediction accuracy of 85%. This was closely followed by Decision Tree, but Support Vector Machine was less ideal. Conclusions: Machine learning methods can produce accurate models in predicting hospital readmissions for patients with AF. The likelihood of readmission to the hospital increases as the patient age, total number of hospital discharges, and total number of patient diagnoses increase. Findings from this study can inform quality improvement in healthcare and in achieving patient-centered care.
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Affiliation(s)
- Man Hung
- Roseman University of Health Sciences College of Dental Medicine, South Jordan, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA.,Utah Center for Clinical and Translational Sciences, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Eric S Hon
- University of Chicago Department of Economics, Chicago, IL, USA
| | - Evelyn Lauren
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Julie Xu
- University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Gary Judd
- Roseman University of Health Sciences College of Dental Medicine, South Jordan, UT, USA
| | - Weicong Su
- University of Utah Department of Mathematics, Salt Lake City, UT, USA
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Using Machine Learning to Predict 30-Day Hospital Readmissions in Patients with Atrial Fibrillation Undergoing Catheter Ablation. J Pers Med 2020; 10:jpm10030082. [PMID: 32784873 PMCID: PMC7564438 DOI: 10.3390/jpm10030082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/02/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022] Open
Abstract
Atrial fibrillation (AF) cases are expected to increase over the next several decades, due to the rise in the elderly population. One promising treatment option for AF is catheter ablation, which is increasing in use. We investigated the hospital readmissions data for AF patients undergoing catheter ablation, and used machine learning models to explore the risk factors behind these readmissions. We analyzed data from the 2013 Nationwide Readmissions Database on cases with AF, and determined the relative importance of factors in predicting 30-day readmissions for AF with catheter ablation. Various machine learning methods, such as k-nearest neighbors, decision tree, and support vector machine were utilized to develop predictive models with their accuracy, precision, sensitivity, specificity, and area under the curve computed and compared. We found that the most important variables in predicting 30-day hospital readmissions in patients with AF undergoing catheter ablation were the age of the patient, the total number of discharges from a hospital, and the number of diagnoses on the patient’s record, among others. Out of the methods used, k-nearest neighbor had the highest prediction accuracy of 85%, closely followed by decision tree, while support vector machine was less desirable for these data. Hospital readmissions for AF with catheter ablation can be predicted with relatively high accuracy, utilizing machine learning methods. As patient age, the total number of hospital discharges, and the total number of patient diagnoses increase, the risk of hospital readmissions increases.
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Allan KS, Aves T, Henry S, Banfield L, Victor JC, Dorian P, Healey JS, Andrade JG, Carroll SL, McGillion MH. Health-Related Quality of Life in Patients With Atrial Fibrillation Treated With Catheter Ablation or Antiarrhythmic Drug Therapy: A Systematic Review and Meta-analysis. CJC Open 2020; 2:286-295. [PMID: 32695978 PMCID: PMC7365832 DOI: 10.1016/j.cjco.2020.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/23/2020] [Indexed: 01/09/2023] Open
Abstract
Background Catheter ablation (CA) is performed in patients with atrial fibrillation (AF) to reduce symptoms and improve health-related quality of life (HRQL). Methods This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated CA of any energy modality compared with antiarrhythmic drugs (AADs) using inverse-variance random-effects models. We searched for RCTs reporting HRQL and AF-related symptoms at 3, 6, 12, 24, 48, and 60 months after treatment as well as the number of repeat ablations. Results Of 15,878 records, we included 13 RCTs of CA vs AADs for the analyses of HRQL, 7 RCTs for the analyses of AF-related symptoms, and 13 RCTs for the number of repeat ablations. For the HRQL analyses at 3 months, there were significant increases in both the Physical Component Summary score (3 months' standardized mean difference = 0.58 [0.39-0.78]; P < 0.00001, I 2 = 6%, 3 trials, n = 443) and the Mental Component Summary score (3 months' standardized mean difference = 0.57 [0.37-0.77]; P < 0.00001, I 2 = 0%, 3 trials, n = 443), favouring CA over AADs. These differences were sustained at 12 months but not >24 months after randomization. Similar results were seen for AF-related symptoms. The number of repeat ablations and success rates after procedure varied considerably across trials. Conclusions Evidence from few trials suggests that CA improves physical and mental health and AF-related symptoms in the short term, but these benefits decrease with time. More trials, reporting both HRQL and AF-related symptoms, at consistent time points are needed to assess the effectiveness of CA for the treatment of AF.
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Affiliation(s)
- Katherine S. Allan
- Division of Cardiology, St. Michael’s Hospital, Toronto, Ontario, Canada
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Corresponding author: Dr Katherine S. Allan, St. Michael’s Hospital, 193 Yonge St, Suite 3-007, Toronto, Ontario M5B 1M8, Canada. Tel: +1-416-864-6060, ×76347.
| | - Theresa Aves
- Division of Cardiology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | | | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - J. Charles Victor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paul Dorian
- Division of Cardiology, St. Michael’s Hospital, Toronto, Ontario, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jason G. Andrade
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Sandra L. Carroll
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Michael H. McGillion
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Healey JS, Carroll SL. Clinical Outcomes in Atrial Fibrillation Research: Shining a Light on a New Path. JACC Clin Electrophysiol 2019; 5:606-607. [PMID: 31122383 DOI: 10.1016/j.jacep.2019.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Sandra L Carroll
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada; School of Nursing, McMaster University, Hamilton, Ontario, Canada
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