The assessment of comorbidity awareness in patients with atrial fibrillation: acapaf study

Elderly patients (≥65y) with atrial fibrillation (AF) have on average five comorbidities. Addressing comorbidities is the first pillar in the AF-CARE model of the new 2024 European Society of Cardiology guidelines of AF management. However, in daily care, there is still a lack of systematic and integrated comorbidity management in AF patients, and patients have low comorbidity awareness.

To evaluate comorbidity awareness of patients with AF, and whether this can be improved through a contact with a nurse specialist at the AF clinic.

This prospective multicenter study included patients diagnosed with AF and being seen for a first visit at the AF clinic at two Belgian hospitals. AF nurses systematically checked the presence or absence of comorbidities using the EHRA-PATHS checklist implemented in a software tool. All included patients were asked to complete an in-house developed comorbidity assessment questionnaire (CAQ) at two time points, i.e. 2 weeks before the consultation (CAQ1) and ≤1 week after the consultation (CAQ2). The questionnaire enlists 9 comorbidities relevant to AF, formulating 3 questions for each of these comorbidities: i) In general, do you think that this condition affects the occurrence of AF and its consequences? ii) Do you have the condition (whether or not treated)? If yes, iii) Are you being treated for it?. Patients had the opportunity to complete the CAQ digitally or via telephone. The Wilcoxon Signed Rank test was used to analyze the CAQ results.

In total, 63 patients (68.1±10.6 y, 71.4% male) completed the CAQ at both time points. After the visit with the AF nurse specialist, patients were significantly more aware that the presented comorbidities can affect AF (median score: CAQ2: 88.9% vs. CAQ1: 77.8%; p< 0.001; Figure 1). However, the median number of comorbidities reported as ‘present’ by the patients was similar during both time points (CAQ1:2(1-3) vs.CAQ2:3(1-4); p=0.254). The number of over- or underestimated comorbidities reported by the patients compared to the AF nurses was similar at both time points (p=0.304; Figure 2). Patients more often underestimated their comorbidities than overestimated them (CAQ1:54.1% vs.14.8%; and CAQ2:52.5% vs.19.7%). Moreover, no ‘shift’ was observed in the number of correctly, underreported, or overreported comorbidities between time points. In addition, the reported comorbidities by the patients and the nurses were also different at both time points (CAQ1:patients vs. nurses; p<0.001 and CAQ2:patients vs. nurses; p= 0.002).

This study showed reasonable knowledge of relevant comorbidities for AF in patients presenting for a first AF visit, although they cannot correctly state which comorbidities are present. A single consultation with a nurse specialist had a limited impact on this suboptimal awareness. More educational efforts are needed to improve comorbidity awareness of patients with AF and potentially impact their overall care.Figure 1  Figure 2