Nurse follow-up visit after the atrial complex ablation: a cross-sectional descriptive study

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) and flutter are complex arrhythmias to ablation because their anatomical location. A navigation system is required to map the ablationable area and in addition, the patient are under general anesthesia. In our hospital, the expert nurse control these patients 10 days afters discharge.

Purpose

To identify the complications and recurrences of arrhythmia that the nurse has detected early and how it has been managed.

Methods

Cross-sectional descriptive study, from September 2020 to January 2022, all patients who underwent complex atrial ablation under total anaesthesia and who were assessed by a nurse 10 days later were included. In the event that any problem arises, the nurse is in charge of managing the network of referrals to specialist doctors.

Results

A total of 159 patients were included with a mean age of 62 years (SD 10.4) and 34% were women. Arrhythmias were 73.5% AF, 11.3% flutter, 14.5% re-do ablations mixed AF/Flutter. CHA2DS2-VASc scale mean 2 points (SD 1.2). Nine cardioversions were scheduled due to early AF recurrence documented. 35% (n=55) of the patients underwent a blood test to control risk factors such as cholesterol, diabetes, kidney failure or thyroid problems. 17.6% (n=28) were programmed for a polysomnography. Cardiologist was consulted in 6.3% (n=10) due to edema of the lower legs, ventricular extrasystoles, asthenia and bradycardia. Interconsultations were also made with endocrinology 1.2%, urology 0.6%, vascular surgery 6.2% and neurology 2.5%. Finally, 12% of patients were referred to their GP for minor controls.

Conclusion

There is little evidence to suggest that nursing consultation could be useful for the early detection of complications and the management of arrhythmia recurrences. More experimental studies are necessary to know the impact of nurse follow-up in the management of patients undergoing complex atrial ablation.

Assessing the impact of education in atrial fibrillation: A systematic review

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial Fibrillation (AF) is the most common heart rhythm disorder. Patient education is recommended as part of comprehensive AF management. Despite this the impact of education alone on outcomes in AF populations is unknown.

Purpose

The aim of this study was to describe the impact of education on clinically relevant outcomes in patient with AF including mortality, hospital admissions, emergency department presentations, stroke and quality of life. 

Methods

The authors searched Pubmed, Embase, CINAHL, Cochrane database and Psycinfo from inception until September 2019. Studies were included if they were prospective and of randomized controlled or observational design with a minimum follow-up 3 months and published in English.

Results

A total of 1667 studies were screened with 37 undergoing full text review and 6 meeting eligibility criteria. There was a total of 588 participants with a mean age of 65.63 ± 11.05 and 60.71% were male. A meta-analysis was unable to be performed due to heterogeneity in reporting of outcomes. Two studies examined the impact of education on mortality with no impact evident from either intervention. The impact of education on hospitalisations (all cause – 3 studies, cardiovascular – 1 study and AF - 2 studies) was explored in five studies with no impact on this outcome from any intervention. Similarly, there was no impact of education on emergency department presentations, except for one study in which a video was used in addition to standardised education. There was no impact on stroke from two studies exploring this outcome. There was no evidence of impact of education on general or AF specific quality of life.

Conclusions

There is little evidence to suggest that educational interventions to date have significantly impacted on death, hospitalisations, emergency department presentations or quality of life in AF populations. There is an urgent need to identify optimal modes and components of educational interventions to improve patient outcomes and reduce health care burden in AF.

Quality evaluation of patient educational resources for catheter ablation of atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

Background

The prevalence of atrial fibrillation (AF) is increasing rapidly with growing utilisation of catheter ablation (CA) as a treatment strategy. Education of individuals undertaking this procedure is diverse, with varying degrees of information provided and little standardisation. Many individuals utilise the internet as an educational resource. However, there is limited regulation of online patient information.

Aims

The purpose of this study was to evaluate the quality of web based  patient education resources for patients undergoing CA in the management of AF.

Methods

A cross-sectional observational study was performed to obtain all freely accessible online educational resources designed to inform AF patients about CA. from inception until 1st October 2019. Three search engines were used: Google, Yahoo! and Bing, using the search terms "atrial fibrillation" and "catheter ablation" combined with "patient information and patient education" in English and Spanish. The Patient Education Materials Assessment Tool (PEMAT) is a validated tool used to evaluate web-based patient education materials as well as  printable tools. The PEMAT score objectively measures the understandability and actionability of printable tools for audio-visual material.

Results

A total of 17 websites and 15 printable tools were included in the analysis. Non-government organizations developed 19% of materials and 75% were created by private or university hospitals. Nineteen materials (59.3%) were rated as highly understandable and 25 materials (21%) were rated as highly actionable, whilst ten materials had an actionability of 0% (6 websites and 4 printable tools).  Less than a half of the materials evaluated were highly rated by the PEMAT score, with a total of 7 websites (41%) and 7 printable tools (46,6%) scoring >70%.

Conclusion

The overall understandability of educational CA material was high, whilst improvement of actionability is warranted. The addition of summaries, visual aids and tools such as checklists may improve quality. These findings have significant implications for developing new patient educational material for CA in AF.