ABSTRACT
BACKGROUND: Authors of studies of patients with atrial fibrillation (AF) have identified several knowledge gaps and misconceptions regarding the condition and its management. The COVID-19 pandemic heightened isolation of patients and underscored the need for education and knowledge building in order for patients to effectively manage AF during times of increased health risk. OBJECTIVE: The aim of this study was to assess, using a qualitative approach, the experiences and perceived benefits of patients with AF regarding an 8-session virtual education intervention (AF-at-Home) during the early months of the COVID-19 pandemic. METHODS: A qualitative study with 3 focus groups using a semistructured focus group guide was conducted and recorded online with the same trained moderator. RESULTS: We identified 7 primary themes emerging from patients' experiences: (1) building knowledge beyond information available in clinic visits, (2) managing anxiety, (3) generating self-efficacy, (4) providing social comparison, (5) perceived benefits of both experiential and informational content, (6) facilitating self-management behaviors, and (7) facilitating communication with providers. CONCLUSIONS: The analysis of the focus groups shows the benefits of a virtual education program in building knowledge, skills, and self-efficacy as well as reducing anxiety and normalizing one's experience by attending a program alongside other patients with AF.
ABSTRACT
BACKGROUND: Physical activity (PA) is an important determinant of cardiovascular health that may be affected the COVID-19 pandemic. Therefore, we examined the immediate and long-term effects of the pandemic and lockdown on PA in patients with established cardiovascular risk. METHODS: Objectively-measured daily PA data was obtained from cardiovascular implantable electronic devices (CIEDs) from 3453 U.S patients (mean and standard deviations [SD] age, 72.65 [13.24] years; 42% women). Adjusted mixed-effects models stratified by device type were used to compare daily PA from periods in 2020: pre-lockdown (March 1-14), lockdown (March 15 to May 8), and the reopening phase of the pandemic (May 9 to December 31) versus 2019. Patient characteristics and events associated with inactivity during lockdown and the proportion of patients who returned to their 2019 PA-level by the end of reopening phase (December 31, 2020) were examined. RESULTS: Daily PA was significantly lower during the lockdown compared to the same period in 2019 (-15%; p < .0001), especially for pacemaker patients, adults aged <65, and patients more active prior to lockdown. Non-COVID hospitalization and ICD shock were similarly associated with low PA during lockdown (p = .0001). In the reopening phase of the pandemic, PA remained 14.4% lower in the overall sample and only 23% of patients returned to their 2019 PA level by the end of follow-up. CONCLUSIONS: In this large cohort of patients with CIEDs, PA was markedly lower during the lockdown and remained lower for months after restrictions were lifted. Strategies to maintain PA during a national emergency are urgently needed.
Subject(s)
COVID-19/epidemiology , Cardiac Resynchronization Therapy Devices , Communicable Disease Control , Exercise , Heart Disease Risk Factors , Aged , Female , Humans , Male , North Carolina/epidemiology , Pandemics , SARS-CoV-2Subject(s)
COVID-19 , Cardiovascular Diseases , Defibrillators, Implantable , Electrophysiologic Techniques, Cardiac , Exercise , Pacemaker, Artificial , Sedentary Behavior , COVID-19/epidemiology , COVID-19/prevention & control , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/physiopathology , Cardiovascular Diseases/psychology , Cardiovascular Diseases/therapy , Child , Communicable Disease Control/methods , Education, Distance , Electrophysiologic Techniques, Cardiac/instrumentation , Electrophysiologic Techniques, Cardiac/methods , Exercise/physiology , Exercise/psychology , Female , Humans , Male , Mental Health , Monitoring, Ambulatory/methods , Monitoring, Ambulatory/statistics & numerical data , North Carolina/epidemiology , Outcome Assessment, Health Care/statistics & numerical data , SARS-CoV-2 , Young AdultABSTRACT
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.