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. 2018 Mar;104(6):494-501.
doi: 10.1136/heartjnl-2017-311800. Epub 2017 Aug 8.

Disease understanding in patients newly diagnosed with atrial fibrillation

Brystana G Kaufman  1 , Sunghee Kim  1 , Karen Pieper  1 , Larry A Allen  2 , Bernard J Gersh  3 , Gerald V Naccarelli  4 , Michael D Ezekowitz  5 , Gregg C Fonarow  6 , Kenneth W Mahaffey  7 , Daniel E Singer  8 , Paul S Chan  9 , James V Freeman  10 , Jack Ansell  11 , Peter R Kowey  5   12 , James A Rieffel  13 , Jonathan Piccini  1 , Eric Peterson  1 , Emily C O'Brien  1
Affiliations

Disease understanding in patients newly diagnosed with atrial fibrillation

Brystana G Kaufman et al. Heart. 2018 Mar.

Abstract

Objective: To describe self-reported disease understanding for newly diagnosed patients with atrial fibrillation (AF) and assess (1) how disease understanding changes over the first 6 months after diagnosis and (2) the relationship between patient understanding of therapies at baseline and treatment receipt at 6 months among treatment-naïve patients.

Methods: We analysed survey data from SATELLITE (Survey of Patient Knowledge and Personal Priorities for Treatment), a substudy of patients with new-onset AF enrolled in the national Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT) II registry across 56 US sites. Patients were surveyed at the baseline and 6-month follow-up clinic visits using Likert scales.

Results: Among 1004 baseline survey responses, patients' confidence in their understanding of rhythm control, ablation, anticoagulation and cardioversion was suboptimal, with 'high' understanding ranging from 8.5% for left atrial appendage closure to 71.3% for rhythm therapy. Of medical history and demographic factors, education level was the strongest predictor of reporting 'high' disease understanding. Among the 786 patients with 6-month survey data, significant increases in the proportion reporting high understanding were observed (p<0.05) only for warfarin and direct oral anticoagulants (DOACs). With the exception of ablation, high understanding for a given therapeutic option was not associated with increased use of that therapy at 6 months.

Conclusions: About half of patients with new-onset AF understood the benefits of oral anticoagulant at the time of diagnosis and understanding improved over the first 6 months. However, understanding of AF treatment remains suboptimal at 6 months. Our results suggest a need for ongoing patient education.

Clinical trial registration: Clinicaltrials.gov. Identifier: NCT01701817.

Keywords: Atrial Fibrillation; Quality of Care; Shared Decision Making; Stroke Prevention.

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Conflict of interest statement

Competing interests: BGK, SK and KP: None. LAA: consultancy from Novartis (significant) and Janssen. JP: significant research support from Boston Scientific, ResMed, ARCA Biopharma, St. Jude Medical Center, Gilead Sciences, Johnson&Johnson, Spectranetics and Janssen and consultancies to Janssen (significant), Spectranetics (significant), Medtronic (significant), Forest Laboratories (modest), Pfizer (modest) and GlaxoSmithKline (modest). EP: significant research support from Eli Lilly & Company, Daiichi Sankyo and Janssen. ECO: significant research grant from Janssen, BMS, Novartis and Pfizer. BJG: consultancies to Janssen Scientific Affairs (significant) and Cipla Limited Data Safety Monitoring Board (modest) for: Mount Sinai St. Lukes, Boston Scientific Corporation, Teva Pharmaceutical Industries, St. Jude Medical, Janssen Research & Development, Baxter Healthcare Corporation, Thrombosis Research Institute, Duke Clinical Research Institute, Duke University, Kowa Research Institute and Cardiovascular Research Foundation. PRK: consultant to Johnson&Johnson (significant). GCF: consultant to Janssen (modest). JAR: consultant and/or speaker’s bureau for Boehringer-Ingelheim, Janssen (significant), Pfizer, BMS, Portola (modest) and Daiichi Sankyo. JVF: consultant to Janssen (modest) and salary support from the American College of Cardiology National Cardiovascular Data Registry. JA: consultancy/advisory board to Bristol-Myers Squibb; Pfizer; Janssen; Daiichi Sankyo; Boehringer Ingelheim; Instrumentation Laboratories; Perosphere; Roche Diagnostics. Equity in Perosphere. MDE: consultancies to Boehringer Ingelheim and Daiichi Sankyo (modest) and Bristol-Myers Squibb, Pfizer, Johnson&Johnson and Janssen Scientific Affairs (significant). GVN: consultant/advisory board to Janssen, Daiichi Sankyo, GlaxoSmithKline, Astra Zeneca; research support from Janssen. PSC: funding from the NHLBI (1R01HL123980). DES: consultant/advisory board to Boehringer Ingelheim, Bristol-Myers Squibb, Merck, Johnson&Johnson, Medtronic, Pfizer; research grants from Boehringer Ingelheim, Bristol-Myers Squibb and Medtronic. KWM: financial disclosures can be viewed at http://med.stanford.edu/profiles/kenneth-mahaffey.

Figures

Figure 1
Figure 1
Proportion of SATELLITE patients with high understanding of atrial fibrillation therapies at baseline and at 6 months. Notes: high understanding was defined as a response of completely or mostly to the question ‘How well would you say you understand the role (rhythm control, ablation) or benefits of using (warfarin, DOAC)’. DOAC, direct oral anticoagulant.
Figure 2
Figure 2
SATELLITE patient understanding of role or options for atrial fibrillation therapies at baseline and use of therapy at 6 months. Notes: the relationship between patient understanding and therapy at 6 months was assessed only for the subset of patients not on the treatment at baseline. Ablation therapy was defined as use of pulmonary vein isolation (PVI). Rhythm control therapy was defined as antiarrhythmic medication.
See this image and copyright information in PMC

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