Dataset Information

Mind the gap: Deficits in fundamental disease-specific knowledge in atrial fibrillation.

ABSTRACT:

Background

Patient success with atrial fibrillation (AF) requires adequate health literacy to understand the disease and rationale for treatment. We hypothesized that individuals receiving treatment for AF would have increased knowledge about AF and that such knowledge would be modified by education and income.

Methods

We enrolled adults with AF receiving anticoagulation at ambulatory clinic sites. Participants responded to survey items encompassing the definitions of AF and stroke, the rationale for anticoagulation, and an estimation of their annual stroke risk. We examined responses in relation to household income and education in multivariable-adjusted models.

Results

We enrolled 339 individuals (age 72.0 ± 10.1; 43% women) with predominantly lower annual income ($20-49,999, n = 99, 29.2%) and a range of educational attainment (high school or vocational, n = 117, 34.5%). Participants demonstrated moderate AF knowledge (1.7 ± 0.6; range 0-2) but limited knowledge about anticoagulation (1.3 ± 0.7; range 0-3) or stroke (1.5 ± 0.8; range 0-3). Income was not associated with improvement in AF (P = 0.32 for trend), anticoagulation (P = 0.27) or stroke knowledge (P = 0.26). Individuals with bachelor or graduate degree had greater AF (1.8 ± 0.5) and stroke (1.6 ± 0.8) knowledge relative to those with high school or vocational training (1.4 ± 0.7 and 1.2 ± 0.9; P ≪ 0.01, both estimates). Education was not associated with understanding the rationale for anticoagulation. Most participants (230, 68%) estimated their annual stroke risk as ≥15%.

Conclusions

We identified consistent, fundamental gaps in disease-specific knowledge in a cohort of adults receiving treatment for non-valvular AF. Improved patient understanding of this complex and chronic disease may enhance shared decision making, patient engagement, anticoagulation adherence, and clinical outcomes in AF.

SUBMITTER: LaRosa AR

PROVIDER: S-EPMC6660978 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Publications

Mind the gap: Deficits in fundamental disease-specific knowledge in atrial fibrillation.

LaRosa Anna R AR Pusateri Alexandra M AM Althouse Andrew D AD Mathier Abigail S AS Essien Utibe R UR Magnani Jared W JW

International journal of cardiology 20190620

<h4>Background</h4>Patient success with atrial fibrillation (AF) requires adequate health literacy to understand the disease and rationale for treatment. We hypothesized that individuals receiving treatment for AF would have increased knowledge about AF and that such knowledge would be modified by education and income.<h4>Methods</h4>We enrolled adults with AF receiving anticoagulation at ambulatory clinic sites. Participants responded to survey items encompassing the definitions of AF and strok ...[more]

PMID: 31256997

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Project description:Background: There is no validated tool to assess patients' knowledge of oral anticoagulant therapy in atrial fibrillation in China. Methods: Using a standard translation program, the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ) was translated into Chinese. The reliability of the JAKQ was assessed by internal consistency (Cronbach's α coefficient), repeatability (test-retest reliability), and sensitivity tests. Effectiveness was assessed by hypothesizing that a lower JAKQ score was a risk factor for bleeding. A total of 447 patients with atrial fibrillation (AF) who were hospitalized between July 2019 and December 2021 were studied and followed up. Participants were followed up 1, 3, 6, and 12 months after enrollment. Bleeding during follow-up was recorded. Data were obtained from hospital databases and telephone follow-up. Result: A total of 447 patients with AF completed JAKQ. The mean age of patients was 67.7 ± 10.2 years. The median JAKQ score was 31.3% (12.5-43.8). The Cronbach's α coefficient of JAKQ was 0.616-0.637, and the test-retest reliability value was 0.902 (p < 0.001). Multivariate logistic regression showed that the higher knowledge level of AF was associated with secondary education or above, an income of more than 2000 yuan, and a history of AF of more than 1 year. Bleeding was associated with a lower JAKQ score, hypertension, and a history of bleeding. Non-bleeding patients on VKA had a better understanding of how often INR should be monitored and what to do if an OAC dose was missed. Conclusion: The Chinese version of JAKQ shows good reliability and validity, indicating that it is a valuable tool for AF and oral anticoagulation (OAC) knowledge assessment. It can be used in clinical practice to guide educational activities and improve the effectiveness and safety of treatment. It was shown that Chinese patients with AF have insufficient knowledge about AF and OAC. Lower JAKQ scores are associated with bleeding, so targeted education is necessary. Targeted educational efforts should focus on patients recently diagnosed with AF and those with lower formal education and income.

Project description:Background/Objectives: In recent years, awareness of sex disparities in atrial fibrillation (AF) and atrial flutter (AFL) has grown, resulting in significant advancements in sex-specific treatment strategies. As these treatment approaches continue to evolve, it is essential to remain attentive to sex-related issues to ensure equitable care for all patients, a point first emphasised by the 2016 AF guidelines. Our objective was the long-term evaluation of sex-specific treatment standards for acute AF/AFL. Methods: This cohort study included cases of acute AF/AFL treated in the emergency department of the Medical University of Vienna, Austria, between 2012 and 2022. The Kaplan-Meier method was used to analyse time-to-event data. The effect of sex on the time to restoration of sinus rhythm was assessed using the log-rank test for unadjusted models and the likelihood ratio test for adjusted models. The groups were categorised based on cases occurring before and after 2016. Results: A total of 3661 cases (55.7% male) were analysed. Before 2016, sinus rhythm was achieved in 70.8% of males and 71.2% of females; after 2016, these rates were 71.8% and 68.6%, respectively. The adjusted model showed a significant effect of sex on the time to restoration of sinus rhythm after 2016 (p = 0.013) but not before (p = 0.865). A subgroup analysis indicated similar results for pharmacologic rhythm control (p = 0.035 vs. p = 0.193). A sensitivity analysis confirmed robustness, with similar effects in both models. The success rate of pharmacological cardioversion was lower in women than in men but was used more frequently in women after 2016. Conclusions: The re-emergence of a sex gap in success rates and time to restoration of sinus rhythm in emergency treatment for acute AF/AFL is concerning and necessitates a re-evaluation of treatment protocols, improved decision-making processes, and further research to ensure equitable, effective, and safe emergency care for all patients.

Project description:IntroductionCurrent U.S. cardiology guidelines recommend oral anticoagulation (OAC) to reduce stroke risk in selected patients with atrial fibrillation (AF), but no formal AF OAC recommendations exist to guide emergency medicine clinicians in the acute care setting. We sought to characterize emergency department (ED) OAC prescribing practices after an ED AF diagnosis.MethodsThis retrospective study included index visits for OAC-naive patients ≥18 years old who were discharged home from the ED at an urban, academic, tertiary hospital with a primary diagnosis of AF from 2012-2014. Five hypothesis-blinded, chart reviewers abstracted data from patient problem lists and medical history in the electronic health record to assess stroke (CHA2DS2-VASc) and bleeding risk (HAS-BLED). The primary outcome was the provision of an OAC prescription at discharge in OAC-naive patients with high stroke risk. Descriptive statistics and multivariable logistic regression assessed associations between OAC prescription and patient characteristics.ResultsWe included 138 patient visits in our analysis, of whom 39.9% (n = 55) were low stroke risk (CHA2DS2-VASc = 0 in males and 1 in females), 15.9% (n = 22) were intermediate risk (CHA2DS2-VASc = 1 in males), and 44.2% (n = 61) were high risk (CHA2DS2-VASc ≥ 2). Of patients with high stroke risk and low-to-intermediate bleeding risk (n = 57), 80.7% were not prescribed an OAC at discharge. Cardiology consultation and female gender, but not stroke risk (CHA2DS2-VASc score), were predictors of an ED provider prescribing an OAC to an OAC-naive AF patient at ED discharge.ConclusionThe majority of OAC-eligible patients were discharged home without an OAC prescription. In OAC-naive patients discharged home from the ED, cardiology consultation and female gender were associated with OAC prescription. Our findings suggest that access to expert opinion may improve provider comfort with OAC prescribing and highlight the need for improved guidelines specific to ED-management of AF.

Dataset Information

Mind the gap: Deficits in fundamental disease-specific knowledge in atrial fibrillation.

Background

Methods

Results

Conclusions

Publications

Mind the gap: Deficits in fundamental disease-specific knowledge in atrial fibrillation.

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