Patient activation for self-management is associated with health status in patients with atrial fibrillation

Abstract

Pamela J McCabe,1 Lynette G Stuart-Mullen,1 Christopher J McLeod,2 Thomas O Byrne,3 Monika M Schmidt,2 Megan E Branda,3 Joan M Griffin3,4 1Mayo Clinic Department of Nursing, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA; 2Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA; 3Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; 4Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA Background: Higher levels of patient activation for self-managing health are associated with positive clinical and health care utilization outcomes. Identifying a patient’s activation level can guide clinicians to tailor interventions to improve their health. Effective self-management of atrial fibrillation (AF) requires patient activation to participate in treatment decisions, prevent complications, and manage risk factors. Yet, little is known about activation in patients with AF. The purpose of this descriptive study was to identify patient activation levels and factors associated with activation in patients with AF. Methods: Patients (N=123), 66% male, with a mean (SD) age of 59.9 (11.3) years seeking treatment for AF at an arrhythmia clinic completed the Patient Activation Measure (PAM), Atrial Fibrillation Severity Scale, Knowledge about Atrial Fibrillation test, Hospital Anxiety Depression Scale, Godin Leisure-Time Exercise Questionnaire, and Patient Assessment of Chronic Illness Care. Sociodemographic and clinical data were obtained from medical records. PAM scores were categorized into Levels 1–4. Associations among patient-reported outcomes, sociodemographic, and clinical variables were analyzed using Fisher’s exact tests and Kruskal–Wallis procedures. Results: The PAM scores of nearly half (45.5%) of the patients were at Level 3, while the scores of 38% were at Level 4. Male sex (P=0.02), higher education (P=0.004), being employed (P=0.005), lower body mass index (P=0.03), tobacco abstinence (P=0.02), less AF symptom burden (P=0.006), less depression (P≤0.0001) and anxiety (P=0.006), greater knowledge of AF (P=0.01), and higher levels of physical activity (P=0.02) were associated with higher activation levels. Conclusion: Higher levels of patient activation in those with AF were associated with a more positive health status and educational attainment. Additional research to describe activation in patients with AF is warranted to identify patients at risk for low activation and to tailor interventions to activation level. Keywords: atrial fibrillation, self-management, patient activation, patient engagement, chronic illness care

Keywords

• Atrial fibrillation
• self-management
• patient activation
• patient engagement
• chronic illness care