Assistant Professor of Teaching UBC Okanagan Lake Country, British Columbia, Canada
Disclosure(s):
Ryan E. Wilson, PhD., RN: No financial relationships to disclose
Background: Atrial fibrillation (AF), the most common sustained arrhythmia, significantly impacts morbidity, mortality, stroke, cognitive decline, and quality of life (QOL), especially in aging populations. Effective management strategies are crucial for improving patient outcomes. Self-care plays a pivotal role in chronic disease management, including AF, by promoting medication adherence, risk factor modification, and symptom self-monitoring. This review aims to synthesize evidence for the impact of AF self-care interventions on various health outcomes. We hypothesize that self-care activities encompassing maintenance, monitoring, and management will lead to improvements in patient-reported outcomes (QOL), clinical outcomes (BMI, blood pressure, stroke), and healthcare utilization compared to usual care.
METHODS AND RESULTS: This systematic review, adhering to the 2020 PRISMA guidelines, analyzed the effectiveness of self-care interventions for AF. Literature spanning from 2005 to 2023 was searched using Medline, Embase, and CINAHL, focusing on "atrial fibrillation" and "self-care." Of the 5,160 articles initially identified, 27 met the inclusion criteria after rigorous screening and were used for data extraction. These studies included a diverse range of designs such as 23 randomized control trials, one prospective clinical cohort, pilot cohorts, and retrospective analyses, covering a wide demographic with 8,181 participants from 13 countries. Riegel’s middle range theory of self-care in chronic disease was used as a framework to guide the analysis and classification of the data.
A diverse range of self-care interventions for AF were delivered in various settings, including hospitals (7 studies), clinics (12 studies), and through digital platforms (9 studies), emphasizing maintenance (19 studies), monitoring (13 studies), and management (21 studies) strategies. Our findings highlight that self-care interventions, whether implemented singly, in dual combinations, or as integrated approaches, significantly enhance patient-reported outcomes, clinical outcomes, and healthcare utilization when compared to usual care. Notably, educational interventions and the integration of mobile and web-based technologies played crucial roles in improving AF management. Such interventions led to better QOL, fewer hospitalizations, and more efficient healthcare utilization.
Conclusion: Incorporating comprehensive, theory-informed self-care interventions into routine clinical practice is essential for the management of AF. The review supports the integration of educational and technological advancements into self-care practices, aligning with recommendations from leading health organizations for a patient-centered, technology-enhanced approach to accommodate the evolving needs of the AF population. This underscores the potential of self-care to mitigate AF's health implications and emphasizes the need for ongoing innovation and evidence-based strategies to enhance patient care.
