Symptoms in Adults with Atrial Fibrillation Seeking Care in Emergency Department
atrial fibrillation AND emergency department
atrial fibrillation treatment seeking
symptomatic atrial fibrillation
symptoms of atrial fibrillation
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PublisherThe University of Arizona.
RightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
AbstractAtrial fibrillation is a common arrhythmia encountered in the emergency department. In the United States, newly diagnosed cases of atrial fibrillation is projected to be 2.6 million cases in 2030 and the annual prevalence of atrial fibrillation is expected to be 12.1 million in 2030 (Colilla et al., 2013). Patients may present to the emergency department for treatment of atrial fibrillation with a variety of symptoms and therefore makes diagnosing atrial fibrillation based on symptomatology challenging for the clinician. The primary goal of this Doctor of Nursing Practice (DNP) project is to describe symptoms of atrial fibrillation in patients that seek medical treatment in the emergency department. Methods: This descriptive study contains secondary analysis of existing data derived from structured interviews that took place at two academic medical centers. This analysis included 74 patients that presented to the emergency department with symptoms suspected of acute coronary syndrome and were later diagnosed with atrial fibrillation. Descriptive statistics were used to synthesize data, while inferential statistics (bivariate tests) were used to compare symptoms between the age groups. Results: The mean age of subjects was 70 + 13 years, ranging 31 to 92 years. The majority of subjects were men (75.7%) and whites (90.5%). The most common symptoms reported by study subjects included chest discomfort (n = 50; 67.6%), followed by generalized weakness (n = 39; 52.7%) and shortness of breath (n = 39; 52.7%), and palpitations/ funny beating of the heart (n = 36; 48.6%) and unusual fatigue/ tiredness (n = 36; 48.6%). Sweating was the only symptom that was statistically significant in the younger adult group than in the older adult age group. Conclusion: The symptoms identified in this DNP project can be used to aid in identifying patients that present to the emergency with symptomatic atrial fibrillation. Further efforts for the assessment of atrial fibrillation should focus on the dissemination of common although nonspecific symptoms to facilitate the inclusion of atrial fibrillation as part of the differential diagnosis.
Degree ProgramGraduate College
Degree GrantorUniversity of Arizona
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Atrial Fibrillation and Patients' Understanding of Risks and Treatment for Stroke Risk ReductionWung, Shu-Fen; Sparenga, Danielle M.; Rothers, Janet L.; Rosenfeld, Anne G. (The University of Arizona., 2019)Background. Arial Fibrillation (AF) is the most commonly encountered cardiac arrhythmia worldwide, and as the average lifespan prolongs, the foreseeable prevalence of AF is increasing (Barra & Fynn, 2015). Oral anticoagulation (OAC) has been identified as the standard treatment for preventing ischemic stroke in AF patients (Barra & Finn, 2014). Suboptimal OAC management has been attributed to lack of awareness and understanding of AF and its potential risks (Vilchez et al., 2014). Half of all US adults cannot read a book written at an eighth grade level, and 45 million are functionally illiterate and read below a 5th grade level (Birru et al, 2004). The ultimate goal of this Doctorate of Nursing Practice (DNP) project is to provide AF patients with readable resources to improve understanding of atrial fibrillation and its risks. Methods. Twenty participants (7 with prior stroke) completed a 19-question survey about AF and a new education guide about AF, Atrial Fibrillation Made Simple; A Patient Education Guide 1.0. Literacy levels will also be described to better determine generalizability of study results. Results. The mean age of the participants was 73 + 6.89 years old, ranging from 58 to 85 years old. The predominant race was Caucasian (n= 16; 80%). Of the 18 participants completed (90%), the mean NVS was 5.11 + 0.34. A two-tailed paired t-test with unequal variance was performed to assess for significance. p= 0.26 indicating no significance in the obtained NVS scale literacy test for this project. Conclusions. Patients with AF are motivated to seek additional educational opportunities and prefer face-to-face time with their healthcare providers to further discuss components of AF and associated risks as well as management of risks and symptoms. Providing patients with an educational guide closer to the average US literacy level provided improved awareness about AF.
Cost-Effectiveness of Apixaban, Dabigatran, Rivaroxaban, and Warfarin for the Prevention of Stroke Prophylaxis in Atrial FibrillationMalone, Daniel C.; Harrington, Amanda Rose; Armstrong, Edward P.; Nolan, Paul (The University of Arizona., 2012)Objective: The primary objective of this study was to estimate the long-term cost-effectiveness of stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in the United States using new anticoagulant therapies - dabigatran 150 mg, apixaban 5 mg, and rivaroxaban 20 mg - as well as the standard treatment, warfarin. Methods: A Markov decision-analysis model was constructed using data from clinical trials that evaluated the new oral anticoagulants relative to warfarin (apixaban 5 mg & ARISTOTLE, dabigatran 150 mg & RE-LY, and rivaroxaban 20 mg & ROCKET-AF) to compare the lifetime cost and quality-adjusted life expectancy. The Markov model target population was a hypothetical cohort of 70-year old patients with nonvalvular atrial fibrillation, an increased risk for stroke (CHADS₂ ≥ 1, or equivalent), a renal creatinine clearance (CrCl) of 50 or above, and no contraindication to anticoagulant therapy. Using pair-wise comparisons of each therapy, analyses were conducted to evaluate incremental cost-effectiveness ratios (ICERs), net monetary benefits (NMBs), lifetime costs, life-years, and quality-adjusted life-years (QALYs). Results: In the base case, warfarin had the lowest cost of $71,857 (95% confidence interval [CI]: $68,730, $77,452), followed by rivaroxaban 20 mg ($74,023; 95% CI: $70,943, $77,307), dabigatran 150 mg ($78,584; 95% CI: $75,277, $81,968), and apixaban 5 mg ($81,180; 95% CI: $78,642, $83,756). Apixaban 5 mg also yielded the highest QALY estimate, 8.63 (95% CI: 8.52, 8.72), followed by dabigatran 150 mg (8.55; 95% CI: 8.43, 8.67), rivaroxaban 20 mg (8.42; 95% CI: 8.31, 8.54), and warfarin (8.17; 95% CI: 8.1, 8.24). In a Monte Carlo probabilistic sensitivity analysis, apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg, and warfarin were cost effective in 45%, 37%, 19%, 0%, respectively, of the simulations using a willingness-to pay threshold of $50,000 per QALY gained. From the one-way sensitivity analyses, new anticoagulant (apixaban 5 mg, dabigatran 150 mg, rivaroxaban 20 mg) costs and probabilities associated with intracranial hemorrhage and stroke for patients receiving rivaroxaban 20 mg were identified as significant influential variables impacting model results. Conclusion: In patients with NVAF and an increased risk of stroke prophylaxis, apixaban 5 mg, dabigatran 150 mg, and rivaroxaban 20 mg may all be cost-effective alternatives to warfarin depending on pricing in the United States and neurologic events for rivaroxaban 20 mg.
Post-Stroke Outcomes in Atrial Fibrillation Patients Treated with Various Oral AnticoagulantsHonkonen, Marcella; Gaerig, Vanesag; Lang, Roxana; Honkonen, Marcella; College of Pharmacy, The University of Arizona (The University of Arizona., 2015)Objectives: Warfarin has historically been the anticoagulant used for the primary prevention of stroke in atrial fibrillation (AF), however three target specific oral anticoagulants, dabigatran, rivaroxaban, and apixaban, have recently been approved for use in this setting. Current literature lacks a comparison of these four drugs in relation to post-stroke outcomes, and this study aims to compare their performance in a natural setting. Methods: This retrospective cohort study identified stroke patients admitted to an academic medical center between January 2013 and December 2014 using the Quintiles, Inc.-American Heart Association Get With The Guidelines-Stroke database; pertinent data was collected from the database and patient electronic medical records. Primary endpoints measured were length of stay, 30-day readmission, and discharge disposition; secondary endpoints included rates of admission to the intensive care unit (ICU) and complications. Results: Of 940 stroke admissions, 53 ischemic stroke patients were identified as receiving an oral anticoagulant for stroke prevention in AF. The warfarin (n=40) and non-warfarin (dabigatran, rivaroxaban, and apixaban; n=13) groups were well matched regarding admission demographics, however patients taking warfarin were more likely to have an elevated INR at hospital admission (P=0.0053) and receive tPA (P=0.047). Patients in the warfarin group were also statistically significantly more likely to receive warfarin on discharge (P=0.004). No endpoints achieved statistical significance. Conclusions: No differences in post-stroke outcomes between warfarin and non-warfarin oral anticoagulants used for stroke prevention in AF were found.