Can nurses help improve self-care of patients living with atrial fibrillation? A focus group study exploring patients' disease knowledge gaps.

Aims: To identify knowledge gaps and preferences for educational material to improve nurse-patient communication and self-care. Design: Using a mixed-methods design, we conducted focus groups and quantitative surveys. Methods: We conducted three focus groups with atrial fibrillation (AF) patients and support persons (N = 17 participants; 66 ± 16 years) at critical treatment junctures (recent diagnosis or medication switch). Patients and support persons were also surveyed on patient activation (self-management skills and knowledge), medication adherence, AF knowledge and health literacy. Iterative thematic analysis was performed using focus group transcripts. Results: Although most participants had adequate health literacy, most reported gaps in AF knowledge. Participants lacked disease-related knowledge and were unsure how to manage health behaviours (e.g. diet and exercise). Few felt they received adequate education from their healthcare provider. Results emphasize the need for consistent information from nursing staff, in lay language, via both electronic and printed means.

Playing it close to the VEST and the clinical guidelines: Clinical guideline compliance in HFrEF patients-Role of WCD.

BACKGROUND: Guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF) has been challenging to achieve universally. Healthcare providers who seek to achieve optimal medical therapy frequently consider either a wearable cardioverter defibrillator (WCD) or an implantable cardioverter defibrillator (ICD) as indicated. The dynamic process of communication and physician recommendations marks a setting to study the relative interdependence of medical therapies and best practice. The purpose of this study was to examine the long-term impact of the WCD on GDMT. We hypothesized the WCD serves as a "gateway" therapy, likely impacting other optimal strategies such that successful use of WCD improves GDMT adherence. METHODS: Electronic medical records (EPIC) were manually reviewed to extract data elements in this observational study of 1289 HFrEF patients from 2013-2015. Data included demographics, comorbidities, and use of GDMT including an ICD use in persistently low ejection fraction (≤36%) patients after 90 days. RESULTS: WCD use was significantly associated with prescribing adherence to GDMT, χ2 (1, N = 981) = 33.36, P < 0.001. Further, WCD use was significantly associated with recommendations for follow-up echocardiographic study, χ2 (1, N = 865) = 66.94, P < 0.001 and use of primary prevention ICD, χ2 (1, N = 1093) = 19.00, P < 0.001. CONCLUSIONS: This study demonstrates the use of the WCD correlates with improved clinician use of GDMT, follow-up echocardiographic studies, and appropriate use of primary prevention ICD. Thus, the potential benefits of the WCD and its care processes may extend beyond prevention of sudden cardiac death to enhanced optimization of GDMT.

The Use of Electronic Personal Health Records to Improve Medication Adherence and Patient Engagement: A Randomized Study of Non-valvular Atrial Fibrillation Patients.

Embolic stroke is a major complication of atrial fibrillation (AF) that frequently results in disability or death. The administration of oral anticoagulation can reduce stroke risk in AF patients; however, medication non-adherence can eliminate this benefit. To date, reported patient adherence rates to oral anticoagulation regimens vary. The objective of the current study was to examine the impact of medication-specific education delivered via a personal health record (PHR) system on medication adherence. A randomized, prospective study was conducted from February 2014 to June 2014 at Parkview Health, a not-for-profit, community-based health care clinic that serves a northeastern Indiana population of more than 820,000. AF patients receiving dabigatran (Pradaxa®; Boehringer Ingelheim GmbH, Ingelheim am Rhein, Germany) to prevent stroke participated in this study. The study participants were predominantly Caucasian males over 65 years of age who were educated, insured, and living above the poverty level. Patients were allowed to view online, download, and transmit health information via a PHR. The intervention group received PHR training and dabigatran education via the PHR. The control group received standard care and PHR access without training. A longitudinal survey pertaining to medication knowledge, medication adherence, and patient engagement was administered at baseline and at the end of the study. Medication-dispensing data collected from pharmacy refill prescriptions were used for calculating the medication possession ratio (MPR). Ninety patients were included in this study, and were randomly assigned to either the intervention group (n = 46) or the control group (n = 44). All participants completed the baseline survey, and 95.6% of patients finished the follow-up survey. The mean score for knowledge increased significantly in the intervention group (from 3.77 to 4.23, p = 0.005), but not in the control group (from 3.70 to 3.95, p = 0.72). The MPR was significantly higher in the intervention group (97.47% vs. 87.67%, p = 0.001). Both groups had similar levels of improvement in Patient Activation Measure scores (from 63.0 to 65.8, p = 0.078 vs. from 63.1 to 63.6, p = 0.814). Patients who used the PHR achieved greater medication knowledge, resulting in improved medication adherence. To our knowledge, no published randomized trial has reported on the use of PHRs to improve medication adherence and knowledge. This study is the first to demonstrate a positive impact on anticoagulation adherence with PHR use.