Disease awareness and knowledge of stroke- and atrial fibrillation risk factors in cardiovascular patients
Authors: Engler D , Bauer L , Brederecke J , Ohlrogge A , Camen S , Boerschel C S , Blankenberg S , Schnabel R B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020-SC1-BHC-30-2019- 847770

Background
Disease awareness is key for the uptake of preventive measures and positively affects self-management of atrial fibrillation patients (AF pat) or those at increased risk of AF. Less evidence exists about pat subjective risk awareness. We aims to identify the predictors of incorrect subjective risk estimation to guide future information of AF pat and stakeholders.

Method
In a prospective cardiology practice cohort (N=1200; age= 59.6 years; 34.4% women) with a median FU of 2.7 years we assessed the subjective estimation of: 1) the risk of stroke and AF in pat with an increased risk of AF (N=292) and 2) the stroke risk of AF pat (N=447). We used a 4-point Likert scale to measure the subjective risk estimation and matched the results with established risk scores and classified pat as "over", "under" and "correct" estimators. For non-AF cases we calculated the risk of incident AF using the CHARGE-AF- and the risk of stroke using a revised Framingham risk score to predict the 10-year probability of stroke. In AF pat we assessed their self-estimated risk of stroke compared to the CHA2DS2-VASc Score. We performed univariable association analyses of risk factors for over- or underestimation for stroke and AF with reference to correct estimators at baseline and FU and performed non-parametric tests for trend.

Results
At baseline N=52 AF pat, 10.6% and N=53 non-AF pat, 17.6% indicated that they are not able to estimate their stroke risk. This also applied for N=97 non-AF pat, 27.8% who were unable to estimate their AF risk. AF pat who underestimated their stroke risk were: significantly older (65.2 vs 59.8 years; p &lt;.001), less frequently men (33.3% vs 44.4 %; p=0.023), had lower body weight (85.3 kg vs 82.5 kg p=0.023), fewer previous strokes (15.1% vs 8.3% p= 0.002) and had a higher chronic disease burden such as diabetes, hypertension, heart failure and coronary heart disease compared to AF pat with correct estimation. Non-AF cases at baseline estimated their AF risk (score value (vs): 1.0 vs 1.5; r= 0.216; p &lt; 0.001) and the stroke risk (sv: 1.3 vs 1.9; r=0.263; p &gt;.001) significantly higher than their current risk to develop the disease. AF risk estimation (sv: 1.2 vs 1.3; r=.216; p =098) and the stroke risk estimation (sv: 1.5 vs 1.4; r=0.035; p=0,458) were comparable to the score assessments in the FU for non-AF cases. AF pat estimated their stroke risk significantly higher than their current risk (sv: 1.0 vs 1.3; r= 0.125; p&lt;.001). The same was observed during FU (score value 1.0 vs 1.3; r= 0.105; p&lt;.001).

Conclusions
More than 10% of pat were unable to give an estimate of their risk due to lack of disease and risk factor knowledge. The minority correctly estimated their risk to develop AF and/or a stroke. Half of the pat overestimated their risk profile. The study identifies predictors related to the awareness and knowledge of the diseases and highlight the need for more explicit educational programs to improve AF awareness.