Beyond Symptom Perception to AF Patient Engagement
The process of engaging patients can be difficult to achieve in the
electrophysiology suite. Scientific statements and international
guidelines have now clearly delineated a multi-pillar or multi-pronged,
disease management approach to AF that activates the four pillars of
rate control, rhythm control, anticoagulation and lifestyle behavioral
approaches.14,15 PROs can emerge as a useful tool as
the daily behaviors of sleep apnea, alcohol use, anxiety/depression,
weight management, medication adherence, sedentary behavior are known to
be contributory to the clinical picture.15 Addressing
these behaviors will require assessment that is mostly dependent on
patient reports. Figure 1 illustrates the side-by-side of key variables
that at least partially rely on patient reports. The creation and
evaluation of multi-disciplinary approaches is needed to address this
host of divergent behaviors across a range of expertise including sleep
medicine, psychology, nutrition, pharmacy, and exercise physiology
further transforms EP. Understanding what each patient wants and need
initiates a process of change of delivery of care.16Clearly, the primary limitations of this approach are patient burden of
reporting and provider capacity to effectively synthesize and address
the information obtained. The challenges are real but the potential
value is significant for patient outcomes.
In summary, PRO-guided rhythm control management is a key strategy and
an integral part of a comprehensive program for management of atrial
fibrillation. This can help standardize patient care and outcomes for
heterogenous populations. A PRO-guided approach towards AF may help in
engagement of patients in understanding their disease process, identify
and risk stratify AF patients for optimum intervention, and improve
healthcare utilization.