Paschoal Elisabete, Olmos Rodrigo D, Gooden Tiffany E, Lotufo Paulo A, Bensenor Isabela, Jolly Kate, Lip Gregory Y H, Neil Thomas G, Greenfield Sheila, Lane Deirdre, Goulart Alessandra C
Center for Clinical and Epidemiological Research, Universidade de Sao Paulo, Sao Paulo, Brazil.
Universidade de São Paulo, Sao Paulo, Brazil.
BMJ Open. 2025 Jun 9;15(6):e088226. doi: 10.1136/bmjopen-2024-088226.
To provide insight into how people cope with living with atrial fibrillation (AF) and taking oral anticoagulants (OACs), informing how services and healthcare delivery could be improved to offer the appropriate support patients require, thereby optimising their quality of life and well-being.
A qualitative study employing focus group discussions (FGDs).
11 primary care units in a socioeconomically deprived area of the Butantan district in São Paulo, Brazil.
Adults (≥18 years) with AF purposively recruited based on sex, age and socioeconomic status.
Saturation was met with three FGDs comprising seven, five and five participants, respectively. Theme one focused on self-management, where many participants discussed their methods for adhering to dietary restrictions and alternative medications, including plant-based options and specific foods, and how they modified their daily activities to reduce AF complications and symptoms. Theme two was rationality, where participants described three main ways that they cope with taking long-term medication (often warfarin): thinking that it controls their AF symptoms; it is an obligation; it prevents morbidity and premature death. Theme three was attitude and emotions, where participants described their initial reactions of shock and fear after diagnosis and ongoing emotions of sadness and frustration due to required self-management activities and regular blood tests. Theme four was medication regimen, where participants discussed difficulties with polypharmacy, changes to AF medication (particularly from non-vitamin K antagonist OACs (NOACs) to warfarin), side effects from taking warfarin and various methods of medication management.
This study presents three key findings with implications for patient care and support. First, the shock and fear experienced during diagnosis due to a lack of knowledge about AF suggests that improvements in public knowledge about AF are needed. Second, people with additional chronic conditions may need improved care and support, given the concern participants had regarding when and how to take their medications safely. Third, improved access to NOACs may reduce the difficulties, frustrations and concerns participants had regarding warfarin use (eg, diet, dose adjustments, self-management and monthly international normalised ratio tests).
深入了解人们如何应对心房颤动（AF）并服用口服抗凝剂（OAC），为改善服务和医疗保健提供方式提供信息，以提供患者所需的适当支持，从而优化他们的生活质量和幸福感。
一项采用焦点小组讨论（FGD）的定性研究。
巴西圣保罗布坦坦区一个社会经济贫困地区的11个初级保健单位。
根据性别、年龄和社会经济地位有目的地招募的成年房颤患者（≥18岁）。
分别由7名、5名和5名参与者组成的3个焦点小组讨论达到了饱和状态。主题一聚焦于自我管理，许多参与者讨论了他们遵守饮食限制和替代药物的方法，包括植物性选择和特定食物，以及他们如何调整日常活动以减少房颤并发症和症状。主题二是合理性，参与者描述了他们应对长期服药（通常是华法林）的三种主要方式：认为它能控制房颤症状；这是一种义务；它能预防发病和过早死亡。主题三是态度和情绪，参与者描述了他们在诊断后最初的震惊和恐惧反应，以及由于需要进行自我管理活动和定期血液检查而持续存在的悲伤和沮丧情绪。主题四是药物治疗方案，参与者讨论了多重用药的困难、房颤药物的变化（特别是从非维生素K拮抗剂口服抗凝剂（NOAC）改为华法林）、服用华法林的副作用以及各种药物管理方法。
本研究提出了三项对患者护理和支持有影响的关键发现。第一，由于对房颤缺乏了解，诊断期间经历的震惊和恐惧表明需要提高公众对房颤的认识。第二，鉴于参与者对何时以及如何安全服药的担忧，患有其他慢性病的人可能需要更好的护理和支持。第三，增加使用NOAC可能会减少参与者对华法林使用的困难、挫折和担忧（例如饮食、剂量调整、自我管理和每月国际标准化比值测试）。
