Exploring patients' needs and perceptions regarding a specialised lifestyle oriented atrial fibrillation outpatient clinic: a qualitative study
Authors: De Louw B , Vinck T , Vermeer J , Dekker L 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the Netherlands Organisation for Health Research and Development (ZonMw).

Background
Atrial Fibrillation (AF) symptom management can be challenging with current treatment strategies. Most risk factors for AF are related to lifestyle and therefore, healthy behaviour among AF patients can improve treatment outcomes. Behaviour change techniques and an integrated care approach have been demonstrated to effectively reduce cardiovascular hospitalisation in AF patients. Furthermore, involving patients in healthcare decision making increases patient participation and improves treatment outcomes. However, needs and perceptions of patients on an AF specialised outpatient clinic have not been studied yet. Patient behaviour can be explained with the Integrated Behavioural Model. This model theorizes that the strongest predictor in behaviour is behavioural intention, which is affected by determinants such as attitude, perceived norm and personal agency. These determinants can be used to understand and influence behaviour. Therefore, the Integrated Behavioural Model attributes to gather insights into patients’ perspectives and needs and may improve AF treatment outcomes.

Purpose
This study aims to identify patients’ needs and perceptions regarding a specialised AF outpatient clinic, to identify essential aspects required for behaviour change techniques to modify important AF risk factors, and to explore the role of the nurse practitioner in risk factor management.

Methods
Study participants were recruited at the specialised AF outpatient clinic of a third-line hospital. Semi-structured interviews were conducted using an interview guide that included topics described in scientific literature regarding risk factor modification and the integrated Behavioural Model. Additionally, perceptions regarding a lifestyle oriented AF outpatient clinic were asked. Transcripts were analyzed using a thematic analysis.

Results
A total of 11 patients were recruited. Qualitative analysis resulted in three main themes: AF symptoms and treatment, current lifestyle behaviours, and expectations for a specialised outpatient clinic. Overall, patients indicated to experience multiple complaints related to AF despite medical therapy and 64% confirmed that AF impairs their Quality of Life. Inadequate knowledge about AF, anxiety, and a worsened stamina are important barriers to execute a healthy lifestyle. Nonetheless, determinants such as social norm facilitate healthy behaviour. In order to improve their lifestyle, patients highlighted they prefer easy accessible health professionals who guide them in symptom management, increase their knowledge about AF and its risk factors, and to improve their lifestyle.

Conclusion
This study confirms that health professionals are important facilitators to increase healthy lifestyle among AF patients. Greater emphasis should be given to an integrated, multidisciplinary care approach to develop a comprehensive intervention programme aimed at changing unhealthy behaviour.