Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Speechley, Mark

2nd Supervisor

Gula, Lorne

Co-Supervisor

3rd Supervisor

Runte, Mary

Affiliation

The University of Lethbridge

Co-Supervisor

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Patients experience the effects of AF from early symptom onset to treatment and beyond. A previous qualitative study found AF to substantially affect patients’ emotional wellbeing, social relationships, employment, and finances. Existing quality of life questionnaires do not adequately assess the AF impact. In this thesis, a new patient-reported questionnaire was developed to measure the impact of AF as experienced by patients. An exploratory factor analysis was conducted on the new questionnaire, revealing five domains: “Affect”, “Social Support”, “Major Life Events”, “Financial Impact”, and “Diagnostic Experience”. Age, marital status, educational attainment, and time of last episode were significantly associated with the overall score. Female gender was associated with a worse diagnostic experience after adjusting for covariates, confirming previous qualitative findings. The new questionnaire has good internal consistency and can be used to study variables associated with the AF impact.

Summary for Lay Audience

The normal heart rate for adults at rest ranges from 60 to 100 beats per minute. Apart from rate, the normal heart also follows a characteristic rhythm that can be detected on an electrocardiogram. Departures from a regular rate or rhythm are referred to as arrhythmias. Atrial fibrillation (AF) is the most common sustained arrhythmia where the heart beats too fast or too slow and out of rhythm. Patients with AF can often feel their hearts pounding or racing and experience symptoms such as chest pain, shortness of breath, difficulty exercising, dizziness, and fatigue. AF can affect a patient’s wellbeing as soon as they begin to experience symptoms. Previously, focus groups and interviews with patients revealed that getting a diagnosis of AF was difficult because some physicians did not take patients’ symptoms seriously. It was also found that AF affected patients’ emotional wellbeing, social relationships, employment, and personal finances.

We developed a questionnaire, called Mapping the Impact of Atrial Fibrillation (MAP-AF), and used it to study the life impacts of AF on patients. A statistical technique called factor analysis allowed us to determine the different areas of peoples’ lives that AF impacts. By examining these areas, or “domains”, we were able to see whether the MAP-AF measures what it was supposed to measure. We found five domains underlying 16 questions. They were “Affect”, or mood, “Social Support”, “Major Life Events”, “Financial Impact”, and “Diagnostic Experience”. The MAP-AF allows us to calculate a total score and a score for each of the five domains for each person. We found patients who were younger, divorced or separated, completed high school or below, or experienced a recent AF episode had higher total scores and were more impacted by AF. Confirming previous findings, our results showed female patients to score higher (i.e., worse) on “Diagnostic Experience” than male patients. After our results are confirmed in a separate group of patients, the MAP-AF questionnaire can be used to study how AF affects the wellbeing of patients, identify patient needs, and improve healthcare services. Timely diagnosis and empathetic care are essential for patient-centered AF management.

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