DeVon, Holli A.

Background: Delay in seeking treatment for symptoms of atrial fibrillation (AF) represents a missed opportunity for early treatment that is critical for reducing serious complications of AF such as stroke and heart failure. Delays ranging from a few days to years after symptom onset have been reported. Little is known about the symptom experiences and cognitive behavioral responses that differentiate those who seek treatment early after symptom onset from those who delay treatment-seeking. Purpose: This study compared symptoms and cognitive behavioral responses of early and late (up to 24 hours versus greater than 24 hours after symptom onset) treatment seekers with symptoms of AF. Methods: A descriptive design was used. Participants (N = 150) were recruited from a Midwest academic medical center. Data regarding 1) type and character of symptoms 2) cognitive and behavioral responses to the symptoms and 3) time from symptom onset to seeking treatment were collected using a structured interview. Independent t-tests for continuous variables and Chi-square tests for categorical variables were used to compare treatment seeking groups. Results: Participants were 51% female, with a mean age of 66.5 SD = 11.1) years. Early treatment seekers (n = 27) were more likely to experience a rapid heartbeat (p <.01), unremitting symptoms (<.001), report fear associated with symptoms (p = .005), and appraise symptoms as very serious (p <.001). They were less likely to believe symptoms could be self-managed (p <.001). Late treatment seekers (n = 123) were more likely to experience fatigue and dyspnea as primary symptoms (p≤ .01), report intermittent symptoms (p <.001), attribute symptoms to stress (p ≤ .02), deconditioning (p <.001), or lack of sleep (p = .009), and take a “wait and see” approach to managing symptoms (p <.001). There were no differences between early and late treatment seekers for age, sex, marital status, education level, and history of coronary artery disease or heart failure. Conclusions: Symptom type and characteristic, and cognitive behavioral responses of early treatment seekers differed from those of late treatment seekers. Experiencing a rapid heartbeat and unremitting symptoms may have helped participants form a cognitive appraisal and behavioral response conducive to early treatment-seeking. Experiencing intermittent symptoms less identifiable with a cardiac origin may have hindered development of cognitive appraisals and behavioral responses that promote early treatment- seeking. Education to promote early treatment-seeking for symptoms should include information about the diverse type and characteristics of symptoms of AF.

Background: The prevalence of atrial fibrillation (AF) is expected to increase 2.5-fold by 2050. As a result, there will be a greater demand for clinicians to provide patient education regarding the nature of AF and its management. Early self-management education is critical to provide patients with knowledge and skills they need to recognize AF, control its progression, and reduce associated complications of stroke and heart failure. Greater understanding of patients’ experiences from symptom onset through initial treatment for AF is needed to guide development of patient centered interventions to promote early effective self-management. Purpose: To describe patients’ experiences from symptom onset through initial treatment of AF. Methods: A descriptive qualitative design was used. Twenty females and 21 males at a Midwest academic medical center were interviewed using open-ended questions to explore their experiences from symptom onset through the initial treatment for AF. Data were analyzed using qualitative content analysis. Results: Participants’ mean age was 64.3 SD = 10.1 years. Themes emerging from data were: 1) understanding the meaning of symptoms 2) learning about AF 3) emotional response and 4) feeling cared for by healthcare providers. Participants were unacquainted with AF and took cues from providers’ responses to appraise their symptoms and diagnosis. Fear and uncertainty were reduced when providers initiated prompt treatment. Receiving clear, comprehensive information about AF was appreciated by participants and described as a factor in feeling cared for by providers. Conclusions: Providers’ played a critical role in reducing patients' emotional distress and helping them to develop an accurate understanding of AF symptoms and treatment. This study provides new insight into participant experiences from symptom onset through initial treatment of AF which may inform development of patient centered interventions to promote early effective AF self-management.

Chronic illness affects >50% of adults in the United States and accounts for >80% of healthcare spending. The purpose of this study was to determine whether beliefs about one’s chronic disease (illness representation) are associated with self-care activation, emergency department (ED) visits, or hospitalizations. Using a cross-sectional design, we recruited older adults with heart failure, chronic obstructive pulmonary disease (COPD), and chronic kidney disease. The Revised Illness Perception Questionnaire (IPQ-R) measured perceptions about disease. The Patient Activation Measure measured self-care activation. ED visits and hospitalizations were measured by self-report. IPQ-R scores were analyzed using latent profile analysis to identify subgroups. Participants included 187 adults (mean age 65 years, 54% female, 74% Black). We found three subgroups (stable, overwhelmed, and confident). Groups did not differ demographically or by disease. The stable group (few consequences, non-fluctuating pattern) had the fewest hospitalizations. The overwhelmed group (many consequences, fluctuating pattern, high negative emotion) had high hospitalizations and low self-care ability. The confident group (high disease control, well-understood) had the highest self-care ability, but also high hospitalizations. ED visits did not differ by group. We found three subgroups that differ in their illness representation and health outcomes. Findings suggest that assessing patients’ illness representations may have important implications for subgroup-specific interventions.

Early detection of atrial fibrillation (AF) is crucial for averting AF-related stroke and heart failure, but treatment is delayed when AF is not recognized. The critical need for early detection and treatment requires education to promote AF awareness. Knowledge deficits, attitudes, and beliefs about AF that should be addressed to improve awareness and reduce treatment-seeking delay in older adults at risk for developing AF have not been well documented. The purpose of this study was to describe knowledge, treatment-seeking attitudes, and beliefs about AF in adults ≥65 years old and identify demographic characteristics associated with knowledge, attitudes, and beliefs. Patients with no history of AF recruited from an academic medical center were interviewed using the Knowledge, Attitudes, and Beliefs about Atrial Fibrillation Survey. Data were analyzed using descriptive statistics and independent t tests. Participants ( N = 180) were 63% male with a mean age of 73.7 ± 6.0 years, and 52% held ≥ 4-year college degree. About one third could not identify common symptoms of AF including palpitations (31%), chest pain (36%), dyspnea (30%), and fatigue (35%). A majority (84%) lacked confidence to recognize AF, and 58% were not sure when they should seek care for AF symptoms. Nearly a third (32%) believed palpitations are always present with AF, and 74% believed that low energy would not be their only symptom of AF. Higher scores for AF Symptom Knowledge ( p = .02) were observed in females, and General Knowledge about AF was greater for younger participants ( p < .001). Participants lacked knowledge and confidence to aid decision-making for treatment-seeking for symptoms of AF and held inaccurate beliefs about AF that could hinder early treatment-seeking. Programs to promote AF awareness should explain the spectrum of symptoms that may be manifested by AF and include action plans for responding to symptoms.

Improving early detection and treatment of atrial fibrillation (AF) is critical because untreated AF is a major contributor to stroke and heart failure. We sought to generate knowledge about the feasibility of conducting a randomized controlled trial to test the effect of the Alert for AFib intervention on knowledge, attitudes, and beliefs about treatment-seeking for signs and symptoms of AF. Adults ≥65 years old (96% White) at risk for developing AF were randomized to receive the Alert for AFib intervention ( n = 40) or an attention control session ( n = 40). Feasibility goals for recruitment, participant retention, adherence, perceived satisfaction and burden, and intervention fidelity were met. From baseline to study completion, knowledge ( p = .005) and attitudes ( p < .001) about treatment-seeking improved more in the intervention group compared with the control group. Results support testing the effectiveness of the Alert for AFib intervention in a large trial.

Early treatment-seeking for symptoms of atrial fibrillation (AF) is critical to avert AF-related stroke and heart failure, but early treatment is hindered if symptoms are not accurately interpreted. The purpose of this research was to describe symptom representation and treatment-seeking responses prior to diagnosis of AF. For this descriptive study, 150 participants were surveyed to describe the type and temporality of symptoms, perceptions regarding the cause, seriousness, controllability of symptoms, and responses to symptoms prior to diagnosis. Participants’ mean age was 66.5 years, and 51% were female. Participants perceived symptoms as having nondisease-based causes, as not very serious, and as amenable to self-management. The majority took a wait and see response with 69% waiting more than 1 week after symptom onset to seek treatment. Lack of recognition of the seriousness of symptoms of AF and delayed treatment put patients at risk of poorer outcomes.

Aims and objectives To describe patients’ experiences from symptom onset to initial treatment for atrial fibrillation. Background The estimated number of individuals with atrial fibrillation globally in 2010 was 33·5 million. World‐wide, each year, new cases of atrial fibrillation approach 5 million, and prevalence will increase 2·5‐fold by 2050. As a result, clinicians worldwide will treat a growing number of patients with atrial fibrillation. Early intervention to promote atrial fibrillation self‐management is critical to reduce associated complications of stroke and heart failure. Greater understanding of patients’ experiences from symptom onset to initial treatment for atrial fibrillation is needed to guide development of interventions to promote early effective self‐management. Design A descriptive qualitative design was used. Methods Twenty females and 21 males at an academic medical centre were interviewed using open‐ended questions to explore their experiences from symptom onset to initial treatment for atrial fibrillation. Data were analysed using qualitative content analysis. Results Participants’ mean age was 64·3 (SD = 10·1) years. Four themes were identified: (1) misinterpreting symptoms; (2) discovering the meaning of atrial fibrillation; (3) facing fears, uncertainty, and moving to acceptance; and (4) receiving validation and reassurance. Participants lacked knowledge of atrial fibrillation and took cues from providers’ responses to appraise symptoms and diagnosis. Fear and uncertainty were reduced when providers initiated prompt treatment and took time to explain atrial fibrillation. Patients appreciated receiving clear information about atrial fibrillation, were engaged in learning, and motivated to participate in their care. Conclusions Providers played a critical role in helping patients to develop an accurate understanding of atrial fibrillation, to cope with the new diagnosis, and motivated them to engage in effective self‐management. Relevance to clinical practice Insight into participant experiences from symptom onset to initial treatment for atrial fibrillation may inform development of interventions to promote effective atrial fibrillation self‐management.