Candidate Advanced Nurse Practitioner Stroke Service & Atrial Fibrillation Clinic, Tallaght University Hospital
Atrial fibrillation (AF) is the most commonly diagnosed disturbance of heart rhythm in adults. In AF, your heart beats in a disorganised, irregular and often rapid way which can lead to a range of symptoms and potential complications.
While Atrial fibrillation (AF) itself may not immediately be life-threatening, it can lead to a stroke or heart failure and so has potentially serious effects. AF is responsible for causing one third of strokes in Ireland each year.
One in four people will develop atrial fibrillation and it is estimated that over 33 million people globally have AF. This figure is projected to increase significantly with our ageing population.
What does the public know about AF?
Therefore, public education about AF is vital, as detection and treatment reduces the risk of stroke.
However, studies have shown that public awareness and knowledge of AF are poor. In a recent Irish study, it was found that overall awareness of AF in the population was low, with only 28% of those surveyed reporting they had heard of AF, and just over half of those correctly able to identify AF as an irregular heartbeat.
Following a short national billboard and radio campaign this marginally improved to 30% of people having heard of the condition, with only 35% able to describe it.
Just 28% people before and 22% after the national campaign knew AF was a risk factor for stroke. The nature of messaging and duration of such public awareness campaigns need greater examination if they are to be effective.
Gaps in patient knowledge of AF
Patient awareness of AF is also important to improve compliance with treatment and understanding of the potential associated complications. International studies suggest that even among patients with AF attending a specialist clinic, one third may not know they have the condition or understand what it means.
At Tallaght University Hospital, professionals at the specialist multidisciplinary AF clinic were disappointed that one in five patients were unaware of the term ‘atrial fibrillation’ although almost half had received education on AF and were returning to the clinic for the second time.
While 60% of all patients reported knowing what AF was, most could only describe it in a low level of detail and half did not identify AF as a risk factor for stroke.
How can AF education be improved?
Up to now, successful stroke awareness campaigns have centred mainly on recognition and response to common stroke symptoms. The concept of AF and its risk of stroke can be a more difficult one to explain to patients, and education may need to be more tailored.
A simple, useful analogy is the ‘faulty cement mixer’: the atrium fails to mix the blood correctly, causing ‘lumps’ (clots) to form in the ‘cement’ (blood) which if flowing out of the mixer and into the pump (ventricle of the heart) will be pumped down the ‘pipe-work’ causing blockage in the blood vessels.
Videos of AF are widely available on YouTube and may also be helpful, but their impact is unstudied and education may need to be more individualised and focused using validated questionnaires to decipher what the patient knows, before coming in for consultation, so specific gaps in knowledge can be addressed. Work is currently underway to produce a national educational tool to help patients understand AF.