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Minjie Z, Zhijuan X, Xinxin S, Shan Q. Mediating effect of coping strategy and psychological status between illness perception and quality of life among patients with atrial fibrillation: a cross-sectional study. BMC Cardiovasc Disord 2024; 24:504. [PMID: 39300328 DOI: 10.1186/s12872-024-04176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND This study investigated the mediating effects of coping strategies and psychological status on the relationship between illness perception and health-related quality of life (HRQoL) among patients with atrial fibrillation (AF). METHODS This cross-sectional study enrolled 178 patients with AF who were admitted to a tertiary hospital in Beijing City in mainland from March 2020 and June 2022. Assessments were made for HRQoL using the Short Form Health Survey depressive symptoms using the Patient Health Questionnaire-9, anxiety using the Generalized Anxiety Disorder-7 (GAD-7), illness perception using the Brief Illness Perception Questionnaire (BIPQ), AF symptoms using the Atrial Fibrillation Severity Scale (AFSS), and coping strategies using the Brief-COPE Scale. RESULTS Significant correlations were observed between illness perception, emotional variables, coping strategies, and HRQoL scores. The regression analysis found that BIPQ, GAD, Maladaptive coping and Problem-focused coping are significant predictors of PCS (F = 20.906, R2 = 0.326, p < 0.01) and MCS (F = 31.24, R2 = 0.419, p < 0.01). Bootstrap samples were used to conduct mediation analysis. The indirect effects of GAD-7 and Problem-focused coping (PC) on the impact of BIPQ on QoL were significant. GAD accounted for 13.2-19.3% of the variance in the total effect across different models, while PC accounted for 22.1-25.8%. The results also indicated a significant chain effect in the illness percepitong-anxiety-coping style-QoL model, which can explain 4.3-10.2% of the total effect, respectively. CONCLUSIONS The perception of illness significantly influenced HRQoL in patients with AF, as mediated by emotional symptoms and coping strategies. This highlights the importance of anxiety and problem-focused coping mechanisms. These findings underscore the need for a holistic, patient-centered approach to AF management that incorporates emotional well-being and coping strategies. TRIAL REGISTRATION Retrospectively registered with ClinicalTrials.gov (NCT05974098). The date of registration: 1 August 2023.
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Affiliation(s)
- Zheng Minjie
- Department of Medical Psychology, Peking University People's Hospital, Beijing, China
| | - Xie Zhijuan
- Department of Medical Psychology, Peking University People's Hospital, Beijing, China
| | - Shi Xinxin
- Department of Medical Psychology, Peking University People's Hospital, Beijing, China
| | - Qu Shan
- Department of Medical Psychology, Peking University People's Hospital, Beijing, China.
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Wahlström M, Medin J, Karlsson MR. Gender differences in health-related quality of life, blood pressure and heart rate among patients with paroxysmal atrial fibrillation after performing MediYoga. IJC HEART & VASCULATURE 2023; 49:101274. [PMID: 37766884 PMCID: PMC10520800 DOI: 10.1016/j.ijcha.2023.101274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Introduction Patients with paroxysmal atrial fibrillation experience low health-related quality of life which can be improved by performing yoga. The aim of this study was to evaluate gender differences in health-related quality of life, blood pressure and heart rate among patients with paroxysmal atrial fibrillation after performing MediYoga. Methods This is a secondary analysis of subgroups, investigating the yoga groups, from two randomized controlled trials (RCT 1: yoga group versus control group, RCT 2: a three-armed randomized study with yoga, control and relaxation groups). The yoga groups performed MediYoga for one hour/week over a 12-week period in both studies. Quality of life (SF-36), blood pressure and heart rate were collected at baseline and end of study. Results No differences were found between the women and men. Within the women's group, there were improvements in vitality (p = 0.011), social function (p = 0.022), mental health (p = 0.007) and Mental Components Summary (p = 0.022). There were differences within the men's group in bodily pain (p = 0.005), general health (p = 0.003), vitality (p = 0.026), social function (p = 0.005), role-emotion (p = 0.011) and Mental Components Summary (p = 0.018). Within the women's group, differences were observed in systolic blood pressure (p = 0.010) and diastolic blood pressure (p = <0.001). The men's group also showed improvement in diastolic blood pressure (p = 0.021). Conclusion MediYoga improved mental health as well as diastolic blood pressure in both men and women with PAF. This study suggests that both men and women, with PAF, may benefit from complementary treatment such as yoga.Clinical Trial Gov Id: NCT01789372.
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Affiliation(s)
- Maria Wahlström
- Karolinska Institutet, Department of Clinical Sciences, Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Box 5035, 114 86 Stockholm, Sweden
| | - Jörgen Medin
- Department of Health Promoting Science, Sophiahemmet University, Box 5035, 114 86 Stockholm, Sweden
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Monica Rydell Karlsson
- Karolinska Institutet, Department of Clinical Sciences, Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
- Ersta Sköndal Bräcke University College, Stockholm, Sweden
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Rush KL, Burton L, Seaton CL, Loewen P, O’Connor BP, Corman K, Phillips R, Moroz L, Andrade JG. Usability and Feasibility Testing of an Atrial Fibrillation Educational Website with Patients Referred to an Atrial Fibrillation Specialty Clinic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6792. [PMID: 37754651 PMCID: PMC10531022 DOI: 10.3390/ijerph20186792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The purpose of this study was to design, usability test, and explore the feasibility of a web-based educational platform/intervention for patients with atrial fibrillation (AF) as part of their virtual AF care. METHODS Participants were patients attending a specialized AF clinic. The multiple mixed-methods design included website design, think-aloud usability test, 1-month unstructured pre-testing analysis using Google Analytics, follow-up interviews, and a non-randomized one-group feasibility test using pre/post online surveys and Google Analytics. RESULTS Usability testing participants (n = 2) guided adjustments for improving navigation. Pre-testing participants' (n = 9) website activity averaged four sessions (SD = 2.6) at 10 (SD 8) minutes per session during a 1-month study period. In the feasibility test, 30 patients referred to AF specialty clinic care completed the baseline survey, and 20 of these completed the 6-month follow-up survey. A total of 19 patients accessed the website over the 6 months, and all 30 participants were sent email prompts containing information from the website. Health-related quality of life, treatment satisfaction, household activity, and AF knowledge scores were higher at follow-up than baseline. There was an overall downward trend in self-reported healthcare utilization at follow-up. CONCLUSIONS Access to a credible education website for patients with AF has great potential to complement virtual and hybrid models of care.
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Affiliation(s)
- Kathy L. Rush
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC V1V 1V7, Canada (C.L.S.)
| | - Lindsay Burton
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC V1V 1V7, Canada (C.L.S.)
| | - Cherisse L. Seaton
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC V1V 1V7, Canada (C.L.S.)
| | - Peter Loewen
- Department of Medicine, University of British Columbia, Vancouver, BC V1V 1V7, Canada; (P.L.); (J.G.A.)
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V1V 1V7, Canada
| | - Brian P. O’Connor
- Department of Psychology, University of British Columbia-Okanagan, Kelowna, BC V1V 1V7, Canada
| | - Kendra Corman
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC V1V 1V7, Canada (C.L.S.)
| | - Robyn Phillips
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC V1V 1V7, Canada (C.L.S.)
| | - Lana Moroz
- Cardiac Atrial Fibrillation Specialty Clinic, Vancouver General Hospital, Vancouver, BC V1V 1V7, Canada
| | - Jason G. Andrade
- Department of Medicine, University of British Columbia, Vancouver, BC V1V 1V7, Canada; (P.L.); (J.G.A.)
- Cardiac Atrial Fibrillation Specialty Clinic, Vancouver General Hospital, Vancouver, BC V1V 1V7, Canada
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Ferguson C, Hickman LD, Lombardo L, Downie A, Bajorek B, Ivynian S, Inglis SC, Wynne R. Educational Needs of People Living with Atrial Fibrillation: A Qualitative Study. J Am Heart Assoc 2022; 11:e025293. [PMID: 35876410 PMCID: PMC9375481 DOI: 10.1161/jaha.122.025293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/16/2022] [Indexed: 12/01/2022]
Abstract
Background This study explored the educational and self-management needs of adults living with atrial fibrillation (AF). Methods and Results This is a qualitative study of adults living with AF, clinicians, and expert key stakeholders. Interviews were conducted via a one-to-one semistructured videoconference or phone and transcribed verbatim for thematic analysis. A total of 34 participants were recruited and included in analyses (clinicians n=13; experts n=13, patients n=8). Interviews were on average 40 (range 20-70) minutes in duration. Three key themes were identified: (1) "Patient-centered AF education"; (2) "Prioritizing AF education"; and (3) "Timing AF education." The availability of credible information was perceived as highly variable. Information primarily focused on anticoagulation, or procedural information, as opposed to other aspects of management, such as risk factor reduction. Factors to optimize learning, such as multimedia, apps, case studies, or the use of visuals were perceived as important. Continuity of care, including engagement of caregivers, was important to help develop relationships, and facilitate understanding, while concurrently creating opportunities for timely targeted education. Clinicians described acute care as a suboptimal setting to deliver education. Competing interests aligned with the time-pressured context of acute care were prioritized over patient education. In contrast, patients valued continuity of care. AF education strategies need to pivot from a "one size fits all" approach and modernize to implement a range of approaches. Conclusions There remain many unmet needs in the provision of quality AF education to support self-management. Multimodal offerings and the ability to tailor to individual patient needs are important design considerations for new education programs.
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Affiliation(s)
- Caleb Ferguson
- Western Sydney Nursing & Midwifery Research CentreWestern Sydney Local Health District and Western Sydney University, Blacktown HospitalBlacktownNew South WalesAustralia
- School of NursingUniversity of WollongongWollongongNew South WalesAustralia
| | - Louise D. Hickman
- School of NursingUniversity of WollongongWollongongNew South WalesAustralia
| | - Lien Lombardo
- Western Sydney Nursing & Midwifery Research CentreWestern Sydney Local Health District and Western Sydney University, Blacktown HospitalBlacktownNew South WalesAustralia
| | - Annie Downie
- Department of CardiologyThe Sutherland HospitalCaringbahAustralia
| | - Beata Bajorek
- Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Serra Ivynian
- Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Sally C. Inglis
- Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Rochelle Wynne
- Western Sydney Nursing & Midwifery Research CentreWestern Sydney Local Health District and Western Sydney University, Blacktown HospitalBlacktownNew South WalesAustralia
- School of Nursing & MidwiferyDeakin UniversityGeelongAustralia
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5
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Wang J, Liu S, Bao Z, Gao M, Peng Y, Huang Y, Yu T, Wang L, Sun G. Patients' experiences across the trajectory of atrial fibrillation: A qualitative systematic review. Health Expect 2022; 25:869-884. [PMID: 35174590 PMCID: PMC9122416 DOI: 10.1111/hex.13451] [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: 10/17/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 12/01/2022] Open
Abstract
Aim This study aimed to synthesize qualitative evidence on experiences of patients with atrial fibrillation (AF) during the course of diagnosis and treatment. We addressed three main questions: (a) What were the experiences of patients with AF during the course of diagnosis and treatment? (b) How did they respond to and cope with the disease? (c) What were the requirements during disease management? Design In this study, qualitative evidence synthesis was performed using the Thomas and Harden method. Data Sources Electronic databases, including PubMed, the Cochrane Library, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, the China Biomedical Database, the WanFang Database, Chinese National Knowledge Infrastructure and VIP, were searched. The databases were searched from inception to August 2021. Review Methods Two researchers independently selected studies using qualitative assessment and review instruments for quality evaluation and thematic synthesis for the data analysis. Results A total of 2627 studies were identified in the initial search and 15 studies were included. Five analytical themes were generated: ‘Diagnosing AF’; ‘The impact of AF on the patients’; ‘Self‐reorientation in the therapeutic process’; ‘Living with AF and QoL’; and ‘External support to facilitate coping strategies.’ Conclusions Our findings point out unique experiences of patients across the trajectory of AF related to delayed diagnosis, feelings of nonsupport, disappointment of repeated treatment failure and multiple distress associated with unpredictable symptoms. Future research and clinical practice are expected to improve the quality of medical diagnosis and treatment, optimize administrative strategy and provide diverse health support for patients with AF. Impact Understanding the experiences and needs of patients with AF in the entire disease process will inform future clinical practice in AF integrated management, which would be helpful in improving the professionalism and confidence of healthcare providers. In addition, our findings have implications for improving the effectiveness of AF diagnostic and treatment services. Patient or Public Contribution This paper presents a review of previous studies and did not involve patients or the public.
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Affiliation(s)
- Jie Wang
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shenxinyu Liu
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhipeng Bao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Gao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuanyuan Peng
- School of Nursing, Sanda University, Shanghai, China
| | - Yangxi Huang
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tianxi Yu
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lin Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Guozhen Sun
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Woo BFY, Bulto LN, Hendriks JML, Lim TW, Tam WWS. The information needs of patients with atrial fibrillation: A scoping review. J Clin Nurs 2021; 32:1521-1533. [PMID: 34390046 DOI: 10.1111/jocn.15993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/29/2021] [Accepted: 07/23/2021] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To identify the atrial fibrillation (AF)-specific information needs of patients with AF. BACKGROUND Patients' understanding of AF is pertinent to optimising treatment and outcomes, thus highlighting the need for effective patient education. The information required to deliver effective AF-specific patient education is less examined. METHODS Guided by Arksey and O'Malley's framework, a scoping review was conducted for studies reporting the AF-specific information needs of patients with AF. Systematic searches were conducted across six databases (Medline, PubMed, CINAHL, Scopus, PsycINFO and ProQuest). All analyses were narrated in prose and outlined in tables. The PRISMA-ScR checklist was used to report this review. RESULTS The systematic search yielded 3816 articles, of which 22 were included. Three major themes emerged from the thematic analysis. Each theme was supported by three subthemes. First, in 'Understanding AF', patients reported the need for 'Easy-to-understand information', information on the 'Screening and diagnosis' of AF and 'Trajectory of disease and its associated risks'. Second, in 'Treating AF', patients required information on the 'Role of anticoagulation', 'Existing or novel therapeutic options' and 'Monitoring effectiveness of treatment'. Lastly, in 'Living with AF', patients needed education in 'Symptom management', 'Secondary prevention of risks' and 'Recognition of emergency situations'. CONCLUSIONS This review has identified the key AF-specific information needs of patients with AF. Being cognisant of the information needs of patients with AF, healthcare providers may become more effective in developing person-centred patient education interventions. RELEVANCE TO CLINICAL PRACTICE Delivering relevant patient education is an important cornerstone for atrial fibrillation care. Nurses by convention play a professional role in patient education. It may be facilitative for nurses to refer to the review findings when developing and implementing patient education interventions. Being in the midst of an ongoing pandemic, patient education strategies may require the use of telecommunication technologies.
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Affiliation(s)
- Brigitte F Y Woo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lemma N Bulto
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Caring Futures Institute, College of Nursing and Helth Sciences, Flinders University, Adelaide, SA, Australia
| | - Jeroen M L Hendriks
- Caring Futures Institute, College of Nursing and Helth Sciences, Flinders University, Adelaide, SA, Australia
- Department of Cardiology Royal Adelaide Hospital, Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia
| | - Toon Wei Lim
- National University Heart Centre, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wilson W S Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Hossain SN, Jaglal SB, Shepherd J, Perrier L, Tomasone JR, Sweet SN, Luong D, Allin S, Nelson MLA, Guilcher SJT, Munce SEP. Web-Based Peer Support Interventions for Adults Living With Chronic Conditions: Scoping Review. JMIR Rehabil Assist Technol 2021; 8:e14321. [PMID: 34032572 PMCID: PMC8188320 DOI: 10.2196/14321] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/27/2020] [Accepted: 04/17/2021] [Indexed: 12/15/2022] Open
Abstract
Background Globally, 1 in 3 adults live with multiple chronic conditions. Thus, effective interventions are needed to prevent and manage these chronic conditions and to reduce the associated health care costs. Teaching effective self-management practices to people with chronic diseases is one strategy to address the burden of chronic conditions. With the increasing availability of and access to the internet, the implementation of web-based peer support programs has become increasingly common. Objective The purpose of this scoping review is to synthesize existing literature and key characteristics of web-based peer support programs for persons with chronic conditions. Methods This scoping review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews guidelines. Studies were identified by searching MEDLINE, CINAHL, Embase, PsycINFO, and the Physiotherapy Evidence Database. Chronic diseases identified by the Public Health Agency of Canada were included. Our review was limited to peer support interventions delivered on the web. Peers providing support had to have the chronic condition that they were providing support for. The information abstracted included the year of publication, country of study, purpose of the study, participant population, key characteristics of the intervention, outcome measures, and results. Results After duplicates were removed, 12,641 articles were screened. Data abstraction was completed for 41 articles. There was a lack of participant diversity in the included studies, specifically with respect to the conditions studied. There was a lack of studies with older participants aged ≥70 years. There was inconsistency in how the interventions were described in terms of the duration and frequency of the interventions. Informational, emotional, and appraisal support were implemented in the studied interventions. Few studies used a randomized controlled trial design. A total of 4 of the 6 randomized controlled trials reported positive and significant results, including decreased emotional distress and increased health service navigation, self-efficacy, social participation, and constructive attitudes and approaches. Among the qualitative studies included in this review, there were several positive experiences related to participating in a web-based peer support intervention, including increased compassion and improved attitudes toward the individual’s chronic condition, access to information, and empowerment. Conclusions There is limited recent, high-level evidence on web-based peer support interventions. Where evidence exists, significant improvements in social participation, self-efficacy, and health-directed activity were demonstrated. Some studies incorporated a theoretical framework, and all forms of peer support—emotional, informational, and appraisal support—were identified in the studies included in this review. We recommend further research on web-based peer support in more diverse patient groups (eg, for older adults and chronic conditions outside of cancer, cardiovascular disease, and HIV or AIDS). Key gaps in the area of web-based peer support will serve to inform the development and implementation of future programs.
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Affiliation(s)
- Saima N Hossain
- Toronto Rehabilitation Insititute, University Health Network, Toronto, ON, Canada
| | - Susan B Jaglal
- Toronto Rehabilitation Insititute, University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - John Shepherd
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Shane N Sweet
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Dorothy Luong
- Toronto Rehabilitation Insititute, University Health Network, Toronto, ON, Canada
| | - Sonya Allin
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Michelle L A Nelson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Sara J T Guilcher
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Sarah E P Munce
- Toronto Rehabilitation Institute - Rumsey Centre, University Health Network, Toronto, ON, Canada
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Waring ME, Hills MT, Lessard DM, Saczynski JS, Libby BA, Holovatska MM, Kapoor A, Kiefe CI, McManus DD. Characteristics Associated With Facebook Use and Interest in Digital Disease Support Among Older Adults With Atrial Fibrillation: Cross-Sectional Analysis of Baseline Data From the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) Cohort. JMIR Cardio 2019; 3:e15320. [PMID: 31758791 PMCID: PMC6883367 DOI: 10.2196/15320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/28/2019] [Accepted: 08/31/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Online support groups for atrial fibrillation (AF) and apps to detect and manage AF exist, but the scientific literature does not describe which patients are interested in digital disease support. OBJECTIVE The objective of this study was to describe characteristics associated with Facebook use and interest in digital disease support among older patients with AF who used the internet. METHODS We used baseline data from the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF), a prospective cohort of older adults (≥65 years) with AF at high stroke risk. Participants self-reported demographics, clinical characteristics, and Facebook and technology use. Online patients (internet use in the past 4 weeks) were asked whether they would be interested in participating in an online support AF community. Mobile users (owns smartphone and/or tablet) were asked about interest in communicating with their health care team about their AF-related health using a secure app. Logistic regression models identified crude and multivariable predictors of Facebook use and interest in digital disease support. RESULTS Online patients (N=816) were aged 74.2 (SD 6.6) years, 47.8% (390/816) were female, and 91.1% (743/816) were non-Hispanic white. Roughly half (52.5%; 428/816) used Facebook. Facebook use was more common among women (adjusted odds ratio [aOR] 2.21, 95% CI 1.66-2.95) and patients with mild to severe depressive symptoms (aOR 1.50, 95% CI 1.08-2.10) and less common among patients aged ≥85 years (aOR 0.27, 95% CI 0.15-0.48). Forty percent (40.4%; 330/816) reported interest in an online AF patient community. Interest in an online AF patient community was more common among online patients with some college/trade school or Bachelors/graduate school (aOR 1.70, 95% CI 1.10-2.61 and aOR 1.82, 95% CI 1.13-2.92, respectively), obesity (aOR 1.65, 95% CI 1.08-2.52), online health information seeking at most weekly or multiple times per week (aOR 1.84, 95% CI 1.32-2.56 and aOR 2.78, 95% CI 1.86-4.16, respectively), and daily Facebook use (aOR 1.76, 95% CI 1.26-2.46). Among mobile users, 51.8% (324/626) reported interest in communicating with their health care team via a mobile app. Interest in app-mediated communication was less likely among women (aOR 0.48, 95% CI 0.34-0.68) and more common among online patients who had completed trade school/some college versus high school/General Educational Development (aOR 1.95, 95% CI 1.17-3.22), sought online health information at most weekly or multiple times per week (aOR 1.86, 95% CI 1.27-2.74 and aOR 2.24, 95% CI 1.39-3.62, respectively), and had health-related apps (aOR 3.92, 95% CI 2.62-5.86). CONCLUSIONS Among older adults with AF who use the internet, technology use and demographics are associated with interest in digital disease support. Clinics and health care providers may wish to encourage patients to join an existing online support community for AF and explore opportunities for app-mediated patient-provider communication.
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Affiliation(s)
- Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Mellanie T Hills
- StopAfib.org, American Foundation for Women's Health, Decatur, TX, United States
| | - Darleen M Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Jane S Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, MA, United States
| | - Brooke A Libby
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Marta M Holovatska
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Alok Kapoor
- Division of Hospital Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - David D McManus
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
- Division of Cardiology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
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Rush KL, Burton L, Van Der Merwe F, Hatt L, Galloway C. Atrial fibrillation care in rural communities: a mixed methods study of physician and patient perspectives. BMC FAMILY PRACTICE 2019; 20:144. [PMID: 31651259 PMCID: PMC6813979 DOI: 10.1186/s12875-019-1029-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/20/2019] [Indexed: 02/04/2023]
Abstract
Background Atrial fibrillation (AF) is a serious heart arrhythmia associated with devastating outcomes such as stroke. Inequitable rural AF care may put patients at risk. Virtually delivered specialty AF care offers a viable option, but stakeholder perceptions of this option within the context of rural AF care is unknown. The study purpose was to obtain patient and primary care physician perspectives of rural AF care and virtually delivered AF care as a potential option. Methods Using a mixed methods design, AF patients (n = 101) and physicians (n = 15) from three rural communities participated in focus groups and/or surveys. Focus group data were thematically analyzed, survey data were descriptively analyzed, and data were triangulated. Results Findings captured patients’ and physicians’ perceptions of prioritized, needs, concerns and problems in AF management, available/unavailable services, and their ideas about virtual AF care. Patients and physicians identified eclectic problems in managing AF. Overall, patients felt ill informed about managing their AF and their most salient problems related to fatigue, exercise intolerance, weight maintenance, sleep apnea, and worry about stroke and bleeding. Physicians found treating patients with co-morbidities and cognitive decline problematic and balancing risks related to anticoagulation challenging. Patients and physicians identified education as a pressing need, which physicians lacked time and resources to meet. Despite available rural services, access to primary and cardiology care was a recurring challenge, and emergency department (ED) use highly contentious but often the only option for accessing care. Physicians’ managed AF care and varied in the referrals they made, often reserving them for complex situations to avoid patient travel. Patients and providers supported a broad approach to virtual AF care, tailored to an inclusive rural patient demographic. Conclusions The study offered valuable physician and patient perspectives on AF care in rural communities including diverse management challenges, gaps in access to primary and specialty services that made ED an often used but contentious option. Findings point to the potential value of virtual care designed to reach patients with AF across the spectrum and geared to local contexts that preserve the vital role of primary care physicians in AF care in their communities.
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Affiliation(s)
- Kathy L Rush
- School of Nursing, University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Lindsay Burton
- School of Nursing, University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | | | - Linda Hatt
- University of British Columbia Okanagan, Psychology, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Camille Galloway
- School of Nursing, University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
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10
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Wahlström M, Rosenqvist M, Medin J, Walfridsson U, Rydell-Karlsson M. MediYoga as a part of a self-management programme among patients with paroxysmal atrial fibrillation - a randomised study. Eur J Cardiovasc Nurs 2019; 19:74-82. [PMID: 31526039 DOI: 10.1177/1474515119871796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Paroxysmal atrial fibrillation is associated with impaired health-related quality of life. Yoga has been suggested to improve health-related quality of life among patients with heart failure and hypertension. AIM The aim of the study was to evaluate the effects of MediYoga, in respect of health-related quality of life, blood pressure, heart rate, as well as N-terminal pro b-type natriuretic peptide, among patients with symptomatic paroxysmal atrial fibrillation, compared with standard therapy or relaxation. METHODS Patients with symptomatic paroxysmal atrial fibrillation, n=132, were stratified for gender and randomised to MediYoga, a relaxation group or a control group, 44 patients per group with a 12-week follow-up. Health-related quality of life, blood pressure, heart rate and N-terminal pro b-type natriuretic peptide were assessed. RESULTS After 12 weeks, there were no differences in health-related quality of life between the groups. There were improvements in Short-Form Health Survey bodily pain, general health, social function, mental health and mental component summary scores within the MediYoga group (p=0.014, p=0.037, p=0.029, p=0.030, p=0.019, respectively). No change was seen in the relaxation and control groups. Systolic blood pressure decreased in the MediYoga group (134±18 to 127±13) compared with the control group (126±17 to 127±15, p=0.041); no difference compared with the relaxation group (131±17 to 125±12). Diastolic blood pressure decreased in the MediYoga group (79±9 to 74 ±9) compared with the control group (76±9 to 79±8, p=0.005); no difference compared with the relaxation group (76±9 to 77±8). There were no differences in heart rate and N-terminal pro b-type natriuretic peptide between the groups after 12 weeks. CONCLUSIONS MediYoga improves health-related quality of life and decreases blood pressure in patients with paroxysmal atrial fibrillation. MediYoga may be used as a part of a self-management programme among patients with paroxysmal atrial fibrillation.
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Affiliation(s)
| | | | | | - Ulla Walfridsson
- Department of Cardiology, Linköping University Hospital, Sweden.,Department of Medical and Health Sciences, Linköping University, Sweden
| | - Monica Rydell-Karlsson
- Department of Clinical Sciences, Karolinska Institutet, Sweden.,Ersta Sköndal Bräcke University College, Sweden
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11
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Knoepke CE, Slack DH, Ingle MP, Matlock DD, Marzec LN. Quality of Medical Advice Provided Between Members of a Web-Based Message Board for Patients With Implantable Defibrillators: Mixed-Methods Study. JMIR Cardio 2018; 2:e11358. [PMID: 31758775 PMCID: PMC6834222 DOI: 10.2196/11358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/18/2022] Open
Abstract
Background Patients use Web-based medical information to understand medical conditions and treatments. A number of efforts have been made to understand the quality of professionally created content; however, none have described the quality of advice being provided between anonymous members of Web-based message boards. Objective The objective of this study was to characterize the quality of medical information provided between members of an anonymous internet message board addressing treatment with an implantable cardioverter-defibrillator (ICD). Methods We quantitatively analyzed 2 years of discussions using a mixed inductive-deductive framework, first, for instances in which members provided medical advice and, then, for the quality of the advice. Results We identified 82 instances of medical advice within 127 discussions. Advice covered 6 topical areas: (1) Device information, (2) Programming, (3) Cardiovascular disease, (4) Lead management, (5) Activity restriction, and (6) Management of other conditions. Across all advice, 50% (41/82) was deemed generally appropriate, 24% (20/82) inappropriate for most patients, 6% (5/82) controversial, and 20% (16/82) without sufficient context. Proportions of quality categories varied between topical areas. We have included representative examples. Conclusions The quality of advice shared between anonymous members of a message board regarding ICDs varied considerably according to topical area and the specificity of advice. This report provides a model to describe the quality of the available Web-based patient-generated material.
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Affiliation(s)
- Christopher E Knoepke
- Division of Cardiology, School of Medicine, University of Colorado, Denver, CO, United States.,Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado, Denver, CO, United States.,Data Science to Patient Value Initiative, School of Medicine, University of Colorado, Denver, CO, United States
| | - D Hogan Slack
- School of Medicine, University of Colorado, Denver, CO, United States
| | - M Pilar Ingle
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado, Denver, CO, United States
| | - Daniel D Matlock
- Adult & Child Consortium for Outcomes Research & Delivery Science, School of Medicine, University of Colorado, Denver, CO, United States.,Division of Geriatric Medicine, School of Medicine, University of Colorado, Denver, CO, United States.,Geriatric Research Education and Clinical Center, Veterans Affairs of Eastern Colorado, Denver, CO, United States
| | - Lucas N Marzec
- Division of Cardiology, School of Medicine, University of Colorado, Denver, CO, United States
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12
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Wahlström M, Rydell Karlsson M, Medin J. Perceptions and experiences of MediYoga among patients with paroxysmal atrial fibrillation-An interview study. Complement Ther Med 2018; 41:29-34. [PMID: 30477856 DOI: 10.1016/j.ctim.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES We investigated the perceptions and experiences of a therapeutic yoga form, MediYoga, which is evolved from Kundaliniyoga among patients with symptomatic paroxysmal atrial fibrillation (PAF). DESIGN AND SETTING an inductive exploratory design was chosen with individual semi-structured interviews. The study was conducted with 12 participants (7 men and 5 women, average age 63.5) at a university hospital, Sweden. Informed consent was obtained from all participants. The data were analyzed using a qualitative content analysis with an inductive method and a manifest approach. RESULTS Three categories were found in the analysis. In the category "A time for a sense of existence and presence", the patients described an increased thoughtfulness and experiences of gaining access to an inner self. The category "A way of gaining well-being and increased consciousness" describes patients` feelings of relaxation and feeling of comfort, with components of mental and physical well-being. Furthermore, "Access to a tool to gain willpower and relieve symptoms" describes the perceptions from patients to obtained access to a tool for handling the emotions, such as fear and anxiety, as well as symptoms that they could struggling with between, and during, their episodes of atrial fibrillation. No adverse events were reported by the yoga group, during the study. CONCLUSIONS Patients with PAF described MediYoga as an accessible tool to manage emotions and symptoms related to episodes of AF. MediYoga may also assist in enhancing body awareness, whereby physical, mental and spiritual components are integrated. MediYoga may strengthen self-management among patients with PAF.
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Affiliation(s)
- Maria Wahlström
- Karolinska Institutet, Department of Clinical Sciences, Department of Cardiology, Danderyd Hospital, 182 88 Stockholm, Sweden; Sophiahemmet University, Lindstedtsvägen 8, 114 28 Stockholm, Sweden.
| | - Monica Rydell Karlsson
- Karolinska Institutet, Department of Clinical Sciences, Department of Cardiology, Danderyd Hospital, 182 88 Stockholm, Sweden; Ersta Sköndal Bräcke University College, Box 111 89, 100 61 Stockholm, Sweden
| | - Jörgen Medin
- Sophiahemmet University, Lindstedtsvägen 8, 114 28 Stockholm, Sweden; The Red Cross University College, Box 1059, SE 141 21 Huddinge, Sweden
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13
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Bergtun S, Oterhals K, Fridlund B. Patients’ experiences 1-6 months after atrial fibrillation ablation: An holistic perspective. J Adv Nurs 2018; 75:150-160. [DOI: 10.1111/jan.13843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/26/2018] [Accepted: 08/17/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Sønneva Bergtun
- Department of Heart Disease; Haukeland University Hospital; Bergen Norway
- Western Norway University of Applied Sciences; Bergen Norway
| | - Kjersti Oterhals
- Department of Heart Disease; Haukeland University Hospital; Bergen Norway
- Western Norway University of Applied Sciences; Bergen Norway
| | - Bengt Fridlund
- Department of Heart Disease; Haukeland University Hospital; Bergen Norway
- Western Norway University of Applied Sciences; Bergen Norway
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14
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Steinhubl SR, Waalen J, Edwards AM, Ariniello LM, Mehta RR, Ebner GS, Carter C, Baca-Motes K, Felicione E, Sarich T, Topol EJ. Effect of a Home-Based Wearable Continuous ECG Monitoring Patch on Detection of Undiagnosed Atrial Fibrillation: The mSToPS Randomized Clinical Trial. JAMA 2018; 320:146-155. [PMID: 29998336 PMCID: PMC6583518 DOI: 10.1001/jama.2018.8102] [Citation(s) in RCA: 298] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
IMPORTANCE Opportunistic screening for atrial fibrillation (AF) is recommended, and improved methods of early identification could allow for the initiation of appropriate therapies to prevent the adverse health outcomes associated with AF. OBJECTIVE To determine the effect of a self-applied wearable electrocardiogram (ECG) patch in detecting AF and the clinical consequences associated with such a detection strategy. DESIGN, SETTING, AND PARTICIPANTS A direct-to-participant randomized clinical trial and prospective matched observational cohort study were conducted among members of a large national health plan. Recruitment began November 17, 2015, and was completed on October 4, 2016, and 1-year claims-based follow-up concluded in January 2018. For the clinical trial, 2659 individuals were randomized to active home-based monitoring to start immediately or delayed by 4 months. For the observational study, 2 deidentified age-, sex- and CHA2DS2-VASc-matched controls were selected for each actively monitored individual. INTERVENTIONS The actively monitored cohort wore a self-applied continuous ECG monitoring patch at home during routine activities for up to 4 weeks, initiated either immediately after enrolling (n = 1364) or delayed for 4 months after enrollment (n = 1291). MAIN OUTCOMES AND MEASURES The primary end point was the incidence of a new diagnosis of AF at 4 months among those randomized to immediate monitoring vs delayed monitoring. A secondary end point was new AF diagnosis at 1 year in the combined actively monitored groups vs matched observational controls. Other outcomes included new prescriptions for anticoagulants and health care utilization (outpatient cardiology visits, primary care visits, or AF-related emergency department visits and hospitalizations) at 1 year. RESULTS The randomized groups included 2659 participants (mean [SD] age, 72.4 [7.3] years; 38.6% women), of whom 1738 (65.4%) completed active monitoring. The observational study comprised 5214 (mean [SD] age, 73.7 [7.0] years; 40.5% women; median CHA2DS2-VASc score, 3.0), including 1738 actively monitored individuals from the randomized trial and 3476 matched controls. In the randomized study, new AF was identified by 4 months in 3.9% (53/1366) of the immediate group vs 0.9% (12/1293) in the delayed group (absolute difference, 3.0% [95% CI, 1.8%-4.1%]). At 1 year, AF was newly diagnosed in 109 monitored (6.7 per 100 person-years) and 81 unmonitored (2.6 per 100 person-years; difference, 4.1 [95% CI, 3.9-4.2]) individuals. Active monitoring was associated with increased initiation of anticoagulants (5.7 vs 3.7 per 100 person-years; difference, 2.0 [95% CI, 1.9-2.2]), outpatient cardiology visits (33.5 vs 26.0 per 100 person-years; difference, 7.5 [95% CI, 7.2-7.9), and primary care visits (83.5 vs 82.6 per 100 person-years; difference, 0.9 [95% CI, 0.4-1.5]). There was no difference in AF-related emergency department visits and hospitalizations (1.3 vs 1.4 per 100 person-years; difference, 0.1 [95% CI, -0.1 to 0]). CONCLUSIONS AND RELEVANCE Among individuals at high risk for AF, immediate monitoring with a home-based wearable ECG sensor patch, compared with delayed monitoring, resulted in a higher rate of AF diagnosis after 4 months. Monitored individuals, compared with nonmonitored controls, had higher rates of AF diagnosis, greater initiation of anticoagulants, but also increased health care resource utilization at 1 year. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02506244.
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Affiliation(s)
- Steven R. Steinhubl
- Scripps Translational Science Institute, La Jolla, California
- Wave Research Center, La Jolla, California
| | - Jill Waalen
- Scripps Translational Science Institute, La Jolla, California
| | | | | | | | - Gail S. Ebner
- Scripps Translational Science Institute, La Jolla, California
- Wave Research Center, La Jolla, California
| | | | - Katie Baca-Motes
- Scripps Translational Science Institute, La Jolla, California
- Wave Research Center, La Jolla, California
| | | | - Troy Sarich
- Janssen Scientific Affairs, Titusville, New Jersey
| | - Eric J. Topol
- Scripps Translational Science Institute, La Jolla, California
- Wave Research Center, La Jolla, California
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