Effect of a virtual self-management intervention for atrial fibrillation during the outbreak of COVID-19

Lindsey Rosman, Tiffany Armbruster, Sayyad Kyazimzade, Zachary Tugaoen, Anthony J Mazzella, Zack Deyo, Jennifer Walker, Sriram Machineni, Anil Gehi, Lindsey Rosman, Tiffany Armbruster, Sayyad Kyazimzade, Zachary Tugaoen, Anthony J Mazzella, Zack Deyo, Jennifer Walker, Sriram Machineni, Anil Gehi

Abstract

Background: As the pandemic continues to unfold, effective, technology-based solutions are needed to help patients with atrial fibrillation (AF) maintain their health and well-being during the outbreak of COVID-19.

Methods: This single-center, pilot study investigated the effects of a 4-week (eight sessions) virtual AF self-management program. Questionnaires were completed at baseline and 1 week after the intervention, and assessed AF knowledge, adherence to self-management behaviors, mental health, physical function, and disease-specific quality of life in patients with AF. Secondary outcomes included knowledge of COVID-19, intervention, acceptability, and satisfaction.

Results: Of 68 patients who completed baseline questionnaires, 57 participated in the intervention and were included in the analysis (mean age of 73.4 ± 10.0 years, 60% male). Adherence to AF self-monitoring behaviors, including monitoring their heart rate (p < .001), heart rhythm (p = .003), and blood pressure (p = .013) were significantly improved at the end of the intervention compared with baseline. Symptom identification (p = .007) and management (p < .001) also improved. Reductions in sleep disturbance (p < .001), anxiety (p = .014), and depression (p = .046) were also observed. Misinformation and inaccurate beliefs about COVID-19 were significantly reduced at the end of the intervention compared with baseline.

Conclusions: This pilot study suggests that a virtual patient education program could have beneficial effects on adherence to guideline-recommend self-care of AF, emotional wellbeing, physical function, and knowledge of COVID-19 in patients with AF. Future randomized studies in larger samples are needed to determine the clinical benefits of the intervention.

Keywords: atrial fibrillation, digital health, intervention; patient education; telehealth.

Conflict of interest statement

Anil K. Gehi, MD: Research Grant: Bristol‐Myers Squib Foundation, Honoraria/Consulting Fees: Biosense‐Webster, Abbott, Biotronik, Zoll Medical. Jennifer Walker, MSN, ANP has received salary support from the Bristol‐Myers Squib Foundation. Sriram Machineni, MD: Research funding: Novo Nordisk, Boeringher Ingelheim, Consulting Fees: Novo Nordisk, Rhythm Pharmaceuticals.

© 2021 Wiley Periodicals LLC.

Figures

FIGURE 1
FIGURE 1
Effects of the atrial fibrillation (AF)‐at‐home program on self‐management skills in patients with AF [Color figure can be viewed at wileyonlinelibrary.com]

References

    1. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio‐Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2020;42:373‐498.
    1. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74:104‐132.
    1. Barnason S, White‐Williams C, Rossi LP, et al. Evidence for therapeutic patient education interventions to promote cardiovascular patient self‐management: a scientific statement for healthcare professionals from the American Heart Association. Circ Cardiovasc Qual Outcomes. 2017;10:e000025.
    1. Clarkesmith DE, Pattison HM, Khaing PH, Lane DA. Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation. Cochrane Database Syst Rev. 2017;4:CD008600‐CD008600.
    1. Kaufman BG, Kim S, Pieper K, et al. Disease understanding in patients newly diagnosed with atrial fibrillation. Heart. 2018;104:494‐501.
    1. Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID‐19 cases: a systematic literature review and meta‐analysis. J Infect. 2020;81:e16‐e25.
    1. Huang C, Wang Y, Li X, et al, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497‐506.
    1. Zheng Y‐Y, Ma Y‐T, Zhang J‐Y, Xie X. COVID‐19 and the cardiovascular system. Nat Rev Cardiol. 2020;17:259‐260.
    1. Reza N, DeFilippis EM, Jessup M. Secondary impact of the COVID‐19 pandemic on patients with heart failure. Circ Heart Fail. 2020;13:e007219.
    1. Thrall G, Lane D, Carroll D, Lip GY. Quality of life in patients with atrial fibrillation: a systematic review. Am J Med. 2006;119:e441‐419.
    1. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta‐analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160:2101‐2107.
    1. Lampert R, Jamner L, Burg M, et al. Triggering of symptomatic atrial fibrillation by negative emotion. J Am Coll Cardiol. 2014;64:1533‐1534.
    1. Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta‐analysis of longitudinal observational studies. Heart. 2016;102:1009‐1016.
    1. Frasure‐Smith N, Lespérance F, Habra M, et al. Elevated depression symptoms predict long‐term cardiovascular mortality in patients with atrial fibrillation and heart failure. Circulation. 2009;120:140.
    1. Beyth RJ, Quinn L, Landefeld CS. A multicomponent intervention to prevent major bleeding complications in older patients receiving warfarin. A randomized, controlled trial. Ann Intern Med. 2000;133:687‐695.
    1. Hendriks JML, de Wit R, Crijns HJGM, et al. Nurse‐led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation. Eur Heart J. 2012;33:2692‐2699.
    1. Kannan V, Wilkinson KE, Varghese M, et al. Count me in: using a patient portal to minimize implicit bias in clinical research recruitment. J Am Med Inform Assoc. 2019;26:703‐713.
    1. Obeid JS, Beskow LM, Rape M, et al. A survey of practices for the use of electronic health records to support research recruitment. J Clin Transl Sci. 2017;1:246‐252.
    1. Lane DA, Ponsford J, Shelley A, Sirpal A, Lip GY. Patient knowledge and perceptions of atrial fibrillation and anticoagulant therapy: effects of an educational intervention programme. The West Birmingham Atrial Fibrillation Project. Int J Cardiol. 2006;110:354‐358.
    1. Hays RD, Spritzer KL, Schalet BD, Cella D. PROMIS(®)‐29 v2.0 profile physical and mental health summary scores. Qual Life Res. 2018;27:1885‐1891.
    1. Spertus J, Dorian P, Bubien R, et al. Development and validation of the Atrial Fibrillation Effect on QualiTy‐of‐Life (AFEQT) questionnaire in patients with atrial fibrillation. Circ Arrhythm Electrophysiol. 2011;4:15‐25.
    1. Holmes DN, Piccini JP, Allen LA, et al. Defining clinically important difference in the atrial fibrillation effect on quality‐of‐life score. Circ Cardiovasc Qual Outcomes. 2019;12:e005358.
    1. Wessler BS, Kent DM, Konstam MA. Fear of coronavirus disease 2019—An emerging cardiac risk. JAMA Cardiol. 2020;5(9):981‐982.
    1. Mutsaerts MAQ, Kuchenbecker WKH, Mol BW, Land JA, Hoek A. Dropout is a problem in lifestyle intervention programs for overweight and obese infertile women: a systematic review. Human Reproduction. 2013;28:979‐986.
    1. Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen. 2012;141:2‐18.
    1. Anderson L, Sharp GA, Norton RJ, et al. Home‐based versus centre‐based cardiac rehabilitation. Cochrane Database Syst Rev. 2017;6:07130.
    1. Desteghe L, Germeys J, Vijgen J, et al. Effectiveness and usability of an online tailored education platform for atrial fibrillation patients undergoing a direct current cardioversion or pulmonary vein isolation. Int J Cardiol. 2018;272:123‐129.
    1. Turchioe MR, Jimenez V, Isaac S, Alshalabi M, Slotwiner D, Creber RM. Review of mobile applications for the detection and management of atrial fibrillation. Heart Rhythm O2. 2020;1:35‐43.
    1. Banerjee A. Bridging the global digital health divide for cardiovascular disease. Circ Cardiovasc Qual Outcomes. 2017;10:e004297.
    1. Ades PA, Keteyian SJ, Wright JS, et al. Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the million hearts cardiac rehabilitation collaborative. Mayo Clin Proc. 2017;92:234‐242.
    1. Shiffman D, Louie JZ, Devlin JJ, Rowland CM, Mora S. Concordance of cardiovascular risk factors and behaviors in a multiethnic US Nationwide cohort of married couples and domestic partners. JAMA Network Open. 2020;3:e2022119‐e2022119.
    1. Richards EA, Franks MM, McDonough MH, Porter K. ‘Let's move:’ a systematic review of spouse‐involved interventions to promote physical activity. Int J Health Promot Educ. 2018;56:51‐67.
    1. Dougherty CM, Thompson EA, Kudenchuk PJ. Patient plus partner trial: a randomized controlled trial of 2 interventions to improve outcomes after an initial implantable cardioverter‐defibrillator. Heart Rhythm. 2019;16:453‐459.
    1. Eapen ZJ, Turakhia MP, McConnell MV, et al. Defining a mobile health roadmap for cardiovascular health and disease. J Am Heart Assoc. 2016;5:e003119.
    1. Hill JA, Agewall S, Baranchuk A, et al. Medical misinformation: vet the message!. Heart Rhythm. 2019;16:332‐333.
    1. Kiss P, Carcel C, Hockham C, Peters SAE. The impact of the COVID‐19 pandemic on the care and management of patients with acute cardiovascular disease: a systematic review. Eur Heart J Qual Care Clin Outcomes. 2020;7(1):18‐27.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren