PATIENTS’ ATTITUDES TOWARDS ATRIAL FIBRILLATION IN AL-NASIRIYAH CITY

Atrial fibrillation (AF) is the most frequent persistent arrhythmia, and it is linked to poor quality of life (QOL), impaired cardiac function, decreased rate of survival, and decreased functional status (Andrade et al., 2020). Atrial fibrillation affects 37,574 million people globally (0.51 percent of the population worldwide), and its prevalence has risen by 33% in the previous 20 years (Lippi & Sanchis-gomar, 2019). Asia continent is home to over half of the population around the world, and its aging population is rapidly increasing. The atrial fibrillation burden will be huge in Asia, and 72 million people in Asia will have AF by 2050, and nearly 3 million of them will develop stroke-related AF (Chiang et al., 2016). According to the statistic of the Ministry of Health in Iraq, the incidence of arrhythmia in Thi-Qar city is increased from 693 in 2015 to 1109 in 2018, so the current study aimed to identify patients' attitude toward AF and their anticoagulation therapy.

Table 1. Demographic characteristics of the patients (N=90)

A total number of (90) AF patients were included in the current study, the Mean of their age was 53.42∓11.52, with the most of patients 26(28.9%) were in the age group of (50-59) years. While patients aged between 60 and 69 years constituted 25 (27.8%) of the study sample. This result is different from the result of a study in which 28.7% of patients were between the ages of (65-and 69) years (Crivera et al., 2016).  Our results differ from the results of a previous study which stated that about (50 %) of the participants were aged ≥ 60 years, and the Mean of their age was 56.2∓ 10.3 (Xu et al., 2010).

Concerning gender, the female got the highest participation rate (51%) than the males’. This is consistent with the result of a study in which the female participants were more than the male 55.7% (Crivera et al., 2016). Contraindicated the result of a study in which the male participants were (53.4% of) the study sample (Janion-Sadowska et al., 2019). Related to the educational level, the highest percentage of participants were patients who graduated from primary school (24.3%) followed by patients who graduated from secondary school (16.8%). These findings were greed with the findings of a study done by Bereznicki et al., in which patients who graduated from primary school (35.8%) were higher than in other graduation categories(Bereznicki et al., 2018). Regarding the occupation of the study participants, most of the patients were housewives which represent (35.6%) of the study participants. The same result was obtained by Ibrahim et al., who found that the majority of participants were housewives (Ibrahim et al., 2019)

Regarding the awareness of the seriousness of the disease (Item 1, 2, and 3), most of the patients’ responses were either neutral or agreed with the fact that atrial fibrillation is a serious disease that can cause serious complications, affecting one’s quality of life if not treated. Concerning Patients’ perceived susceptibility to AF (items 4, 5, and 6), the majority of the patients’ responses were neutral about fearfulness of complications from atrial fibrillation someday, and also about the ease with which they have atrial fibrillation episodes.

Concerning perceived benefit (items 7, 8, 9, 10, and 11), more than half of the study sample (51.1%) were agreed that the medication used to prevent AF complications saves more money than the treatment of complications if it occurs, while (67.7%) of patients’ responses agreed towards the importance of adopting a healthy lifestyle to improve their AF, also (66.6%) of patients demonstrated that AF can be improved by the use of proper medications, this is consistent with the result of a study in which patients were highly satisfied with their medications that were offered for treatment of AF(Aliot et al., 2010). approximately one-third of patients disagreed about the use of smartphone apps for pulse monitoring or for reminding them of the treatment time

About the perceived barriers (items 12, 13, and14), approximately (31.1%) of patients demonstrated that it is unnecessary to take their anticoagulants if they did not have an embolic complication, while (27.8%) of patients reported that taking their medication on a regular schedule is not convenient, and it is more convenient to take it only if they feel uncomfortable. About the importance of the periodic follow-up, about (26.7% of patients) were disagreed and considered it a waste of time. The findings of a previous study (Xu et al., 2010) were relatively similar to our results, in which (45%) of patients agreed that the follow-up is a waste of time, while eighteen percent reported that it is troublesome to take medication on regular basis.

Concerning the motivations used to maintain health (items 15, 16, and 17), the highest rate of responses which is about (75.6 %) of patients agreed that the medical staff’s instructions are more reliable than other instructions obtained through TV and others media. Concerning the relation between AF and stress, (50%) of patients agreed about the importance of controlling stress to improve their AF, while (36.7%) of their responses were neutral towards the relation between AF and stress. 58.9 % of patients agreed about the importance of periodic follow-up and pulse monitoring for early-stage detection of health problems or detecting episodes of asymptomatic AF, while (35%) of patients’ responses were neutral.

The finding of the overall patients’ attitude demonstrated that (57.8%) of patients exhibited a neutral response towards their AF while only 33 out of 90 patients had a positive attitude. Patients’ neutral responses indicate they did not know much about AF, so they were not confident of the accuracy and validity of their responses, so they choose to be neutral. The Mean score of Patients’ attitudes was (43.91±7.43) which is lower than the Mean score of a previous study done in China by (Xu et al., 2010) in which the Mean score was 71.23±6.64. Finally, this result is consistent with the result of a study that revealed  a need for improvement in patients’ education for achieving the better outcome and increase compliance with their anticoagulants(Amara et al., 2015)

The attitudes of the patients were influenced by the level of education (p=0.056), as patients with high diplomas had a more positive attitude toward AF than those with low education level, also patients who are an employer or retired demonstrated an improved attitude than other patients who were self- employers and housewives. This variation may be related to their self-learning ability, and also their ability to acquire and understand knowledge.

CONCLUSIONS

The majority of the patients had a neutral attitude toward AF, with significant variation in attitudes among patients concerning their levels of education and occupation. Therefore an educational program about AF should be established for patients to improve their attitude, and this will help the patients in achieving better self-management and adopting healthy behaviors.

ETHICALCONSIDERATIONSCOMPLIANCEWITHETHICALGUIDELINES

All patients were informed about the current study and its aims, and then verbal consent was obtained from participants to participate in the study. Also, the patient was told that they have the right to agree or refuse to participate in the study. Regarding confidentiality and anonymity of participants, ethical approval was obtained from the ethical committee of research in the faculty of Nursing/ University of Baghdad

FUNDING

This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

AUTHOR’SCONTRIBUTIONS

Study concept; Writing the original draft; Data collection; Data analysis and Reviewing the final edition by all authors.

DISCLOSURESTATEMENT: The authors report no conflict of interest.

ACKNOWLEDGEMENTS

We thank the author of the study xu et al.,  from which the attitude scale was adopted after granting us permission for using it.

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