Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
Divisions of Imaging Sciences & Biomedical Engineering & Cardiovascular Medicine, King's College London, UK.
Br J Health Psychol. 2018 Feb;23(1):3-21. doi: 10.1111/bjhp.12267. Epub 2017 Sep 5.
Persistent atrial fibrillation (AF) is an abnormal heart rhythm associated with low quality of life (QoL) and significant health-related costs. The purpose of the study was to examine patients' illness and treatment beliefs and ways of coping with AF symptoms, to provide insight into promoting better QoL and treatment-specific management.
Beliefs were explored across three procedural treatment groups using a qualitative cross-sectional design.
Thirty semi-structured interviews were carried out with patients undertaking cardioversion (n = 10), catheter ablation (n = 11) and atrioventricular node ablation (n = 9). Interviews were transcribed and analysed using inductive thematic analysis with elements of grounded theory.
An overarching theme of a vicious cycle was evident, which related to perceived lack of knowledge and understanding of AF, attempts to control symptoms and negative emotional reactions to failed control attempts. This vicious cycle related to three subordinate themes: (1) unpredictability and uncertainty of AF and symptoms; (2) coping with symptoms through (a) avoidance (b) all-or-nothing- (c) slowing down behaviours; and (3) concerns and expectations about treatment.
Patients outlined a need to gain control of unpredictable symptoms by monitoring and varying activity levels. These behaviours were often appraised as ineffective at controlling symptoms, leading to heightened uncertainty and increased activity avoidance. Treatment concerns escalated with increasing number and invasiveness of procedures. Improving AF patients' perceived understanding of their illness and treatment and promoting more effective symptom-management strategies may alleviate psychological distress and improve QoL. Themes elaborated on the common-sense model whereby patients' beliefs about illness and treatment interact with coping behaviours. Statement of contribution What is already known about this subject? Quality of life (QoL) is disproportionately low in people with persistent atrial fibrillation (psAF). The common-sense model suggests illness perceptions and coping predict QoL in chronic illnesses. No previous studies have examined the idiosyncratic beliefs and coping behaviours of psAF patients. What does this study add? A vicious cycle of perceived lack of understanding of AF, attempts to control AF and distress at failed attempts at control, was a key theme. PsAF patients reported continued avoidance/all-or-nothing behaviours despite symptomatic relief post-procedure, and disengagement from enjoyable activities. PsAF patients reported procedure-specific concerns/expectations, which could be targeted in future interventions aimed at reducing distress.
持续性心房颤动（AF）是一种异常的心律，与生活质量（QoL）降低和与健康相关的费用显著增加有关。本研究的目的是探讨患者对疾病和治疗的信念以及应对 AF 症状的方式，以深入了解如何改善 QoL 和特定于治疗的管理。
使用定性横断面设计，在三个程序治疗组中探讨信念。
对接受心脏复律（n=10）、导管消融（n=11）和房室结消融（n=9）的患者进行了 30 次半结构化访谈。使用归纳主题分析对访谈进行了转录和分析，并结合了扎根理论的元素。
一个明显的恶性循环总主题与对 AF 和症状缺乏认知和理解、试图控制症状以及对控制尝试失败的负面情绪反应有关。这个恶性循环与三个下属主题有关：（1）AF 和症状的不可预测性和不确定性；（2）通过（a）回避（b）全有或全无（c）减缓行为来应对症状；（3）对治疗的担忧和期望。
患者概述了通过监测和改变活动水平来控制不可预测症状的需求。这些行为通常被评估为控制症状无效，导致不确定性增加和活动回避增加。随着程序数量和侵入性的增加，治疗担忧加剧。提高 AF 患者对疾病和治疗的认知，并促进更有效的症状管理策略，可能会减轻心理困扰并提高 QoL。主题阐述了常见的疾病感知模型，即患者对疾病和治疗的信念与应对行为相互作用。
关于这个主题，目前已知的内容是什么？持续性心房颤动（psAF）患者的生活质量（QoL）显著降低。常见的疾病感知模型表明，慢性病患者的疾病感知和应对方式预测 QoL。以前没有研究检查过 psAF 患者的特殊信念和应对行为。这项研究有什么新发现？缺乏对 AF 的理解、试图控制 AF 和对控制失败的困扰的恶性循环是一个关键主题。尽管手术后症状缓解，psAF 患者仍继续回避/全有或全无行为，并且不参与愉快的活动。psAF 患者报告了特定于程序的担忧/期望，这可以在未来旨在减少痛苦的干预措施中加以解决。
