The impact of an educational intervention on physiological outcomes among patients with atrial fibrillation: a meta- review

Introduction/ background Atrial fibrillation (AF) is the most prevalent sustainable cardiac arrhythmia globally, with one in four people at risk of developing the disorder in their lifetime.1 AF is associated with significant morbidity and mortality rates with one third of ischemic strokes attributed to the condition.2 People with an AF diagnosis are also five times more likely to develop heart failure, and twice as likely to die from cardiovascular disease.2 AF also has significant economic implications, as it is affiliated with frequent hospital admissions and can complicate the management of co- morbidities. Despite this, patient knowledge surrounding AF is often limited, and as such, this may contribute towards ineffective self-management.4-5. The European Society of Cardiology (ESC) Guidelines (2020) for the diagnosis and management of AF advise that disease specific education plays an essential role in adherence to pharmacological therapies in AF.6 In addition, AF specific education programmes may help reduce modifiable risk factors associated with AF exacerbations and complications.7-9 Whilst educational interventions have been successful at reducing physiological complications in other chronic conditions,9-10 this approach is not always well integrated or evaluated when it comes to managing patients with a diagnosis of AF. Aim The aim of this meta- review was to synthesize the existing evidence on the impact of educational interventions on physiological outcomes in patients with AF. Methods A meta- review of published systematic reviews was conducted. Four databases were searched. Two authors critically appraised and extracted data from the six reviews with a third acting as an adjudicator. Six systematic reviews were synthesized. The AMSTAR-2 tool was used to critically appraise the quality of the selected studies. Results The results from six systematic reviews were synthesized using a narrative approach. Overall, the results from this meta- review demonstrate a strong association between educational interventions for patients with AF and enhanced physiological outcomes. Significant reductions in all- cause mortality rates as well as all- cause cardiovascular hospitalizations were observed. Improvements in Health- related Quality of life were also evident with improvements in anxiety, depression, vitality, role limitation/ emotional issues and physical functioning observed. Bleeding- related complications were also less- frequently reported among those in intervention groups. Conclusion This meta- review details a comprehensive analysis of the correlation between educational interventions and enhanced physiological outcomes in patients with AF. Incorporating interventions into clinical practice may prove a cost- effective way to reduce AF- related physiological complications such as mortality rates as well as a reduction in hospitalisations. This review highlights the need for individualised, targeted education for patients with AF.