1. Lindsey Saunders, RN,BSN April 7, 2014 NURS 7940 ATRIAL FIBRILLATION AND QUALITY OF CARE

2. BACKGROUND AND SIGNIFICANCE  A decreased quality of life is common in patients with atrial fibrillation (AF) often due to misunderstandings about atrial fibrillation, symptoms and treatment management.  Education is of great importance in this population and has been shown to produce a greater quality of life.

3.  Pico Question: “What is the effectiveness of patient specific education in relation to the overall patient outcomes in the treatment of non-valvular atrial fibrillation in patients 18 years and older?” PICO

4.  Databases searched included CINAHL, Medline, and Academic Search Premier.  5 quantitative studies were found including 2 Systematic Reviews, a Meta-analysis, and 2 RCTs. A Prospective cohort study, Case Control Study, a Retrospective cohort study and a Current Opinion article were used. A Clinical Practice Guideline from the American Heart Association was also used. SEARCH STRATEGY

5.  The recommendations from the evidence researched have great implications on how we educate and practice and have been shown effective in increasing quality of life.  Grade A  Providing education based on the patient’s current understanding of the disease and personal beliefs  Providing education tailored to each patient and their current treatment plan  Grade B  Providing continuous support to patients  Practicing effective communication SUMMARY OF EVIDENCE

6.  Setting: Outpatient Cardiovascular Treatment Center at Baptist Medical Center South  Participants: Men and women at least 18 years old with a diagnosis of atrial fibrillation at an outpatient treatment center. SMALL TEST OF CHANGE GenderN% Male660 Female440 RaceN% White660 Black440

7.  Implementation Steps:  Informed consent was obtained  Atrial Fibrillation Effect on QualiTy of life (AFEQT) questionnaire was administered to each participant to assess their current quality of life.  AFEQT measures the patient’s perception of symptoms, functional impairment, treatment concerns and satisfaction using a likert scale: 1-7 (1= not bothered or limited; 7= extremely bothered or limited).  Education was tailored and provided for each participant using The American Heart Association’s “Living with Atrial Fibrillation” brochure. SMALL TEST OF CHANGE

8.  Evaluation  Follow up phone calls were made after 1 month of receiving the education.  Participants were given AFEQT questionnaire during 1 month follow up.  The pre and post education AFEQT questionnaires were compared to assess for a greater quality of life.  Lower scores = greater quality of life SMALL TEST OF CHANGE

9.  Results  Providing patient specific education to patients with atrial fibrillation was shown to significantly increase the quality of life in 4 categories after a 4-6 week follow up.  Symptom Management (p= 0.001)  Activity Restriction (p= 0.001)  Medication Management (p= 0.000)  Treatment Satisfaction (p= 0.007) SMALL TEST OF CHANGE

10.  Patient’s opinion on how education improved their quality of life: SMALL TEST OF CHANGE

11.  A greater level of education tailored to each patient has been shown to promote a better understanding of the disorder and treatments which will lead to a increased quality of life.  Continually assessing the patient’s quality of life and providing specific education for each patient is essential in providing effective care and management to patients in a Nurse-led Atrial Fibrillation Management Clinic.  More emphasis should be placed on providing adequate and detailed education to each patient in daily practices. CONCLUSION

12.  American Heart Association, Atrial Fibrillation. (2012). Treatment & Prevention of AF. Retrieved from: http://www.heart.org/ HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/Atrial- Fibrillation-AF-or-AFib_UCM_302027_Article.jsp  Berti, D., Hendriks, J., Brandes, A., Deaton, C., Crijns, H., Camm, A.J., Hindriks, G.,Moons, P., Heidbuchel, H. (2013). A proposal for interdisciplinary, nurse-coordinated atrial fibrillation expert program as a way to structure daily practice. European Heart Journal 34, 2725-2730. Doi:10.1093/eurheartj/eht096.  Camm, A., Lip, G., Caterina, R., Savelieva, I., Atar, D., Hohnloser, S.,… Kirchhof, P. (2012). 2012 focused update of the esc guidelines for the management of atrial fibrillation. Eurospace, 14, 1385-1413. Doi:10.1093/eurospace/eus305x  Goli, N.M., Thompson, T., Sears, S.F., Mounsey, J.P., Chung, E., Shwartz, J.,…Gehi, A.K. (2012). Educational attainment is associated with atrial fibrillation symptom severity. PACE, 35, 1090-1096.  Hendriks, J., Nieuwlaat, R., Vrijhoef, H., Wit, R., Crijns, H., Tieleman, R.G. (2010). Improving adherence guidelines in the treatment of atrial fibrillation by implementing an integrated chronic care program. Netherlands Heart Journal 18 (10), 471-477.  Hendriks, J., Wit, R., Crijns, H., Vrijhoef, H., Prins, M., Pisters, R., Pison, L., Blaauw, Y., Tieleman, R.G. (2012). 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. European Heart Journal 33, 269.2699.Doi:10.1093/eurheartj/ehs071  Schector, S.R. & Lynch, J. (2011). Health learning and adult education: in search of theory of practice. Adult Education Quarterly, 6(3), 207-224.  Spertus,J., Dorian, P., Bubien, R., Lewis, S., Godejohn, D., Reynolds, M.R., Lakkireddy, D.R. (2011). Development of the atrial fibrillation effect of quality of life (AFEQT) questionnaire in patients with atrial fibrillation. Circulation: Arrhythmia and Electrophysiology 4, 15-25. doi: 10.1161/CIRCEP.110.958033  Zolnierek, K.B. & DiMatteo, M.R. (2009). Physician communication and patient adherence to treatment: a meta-analysis. Medcare, 47(8), 826-834. Doi:10.1097/MLR.06013e31819a5acc REFERENCES

13. QUESTIONS?