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.