Identifying rehabilitation needs as part of secondary prevention in individuals with Atrial Fibrillation - a Delphi consensus study

Abstract

Aim: This study aimed to establish general consensus on a systematic needs assessment model to determine eligibility for cardiac rehabilitation (CR) as part of secondary prevention in individuals with atrial fibrillation (AF). Specific objectives included identifying relevant needs assessment criteria and establishing consensus on referral criteria.

Methods: A Delphi study was conducted following the ACCORD guidelines (ACcurate COnsensus Reporting Document) with participation of an international, multi-disciplinary expert panel including physicians, nurses and other healthcare professionals, across primary and secondary care as well as academic research. The panel also included six people who had AF themselves. The Delphi process involved three iterative rounds of surveys and a video meeting to determine needs assessment criteria and facilitate consensus. Data collection included qualitative feedback and quantitative voting on proposed criteria.

Results: Sixty-nine experts participated. There was high agreement on the importance of the study, which identified 12 needs assessment criteria related to AF symptom burden, health-related quality of life, anxiety, medicine adherence, and various risk factors. Whilst there was agreement on the needs assessment model, experts noted that referral criteria should be flexible and tailored to local healthcare settings, emphasizing that each individual's situation is unique.

Conclusion: This Delphi study established a needs assessment model that can be adapted to local contexts for individuals with AF. More research is needed to refine referral criteria and ensure effective implementation of individually tailored CR strategies.

Keywords: Atrial Fibrillation; Cardiac Rehabilitation; Consensus; Delphi Technique; Needs Assessment; Secondary prevention.