Exploring patient engagement in atrial fibrillation with multimorbidity: impact on quality of life, medication adherence and healthcare perceptions—a multicountry cross-sectional study

Objective To examine patient engagement (PE) levels of atrial fibrillation (AF) patients with multimorbidity, to identify distinct personas based on sociodemographic and clinical characteristics, as well as engagement levels, and to compare PE in disease management with health-related quality of life, medication adherence, and perceptions of care quality. Design A cross-sectional survey. Setting Data were collected through an online survey platform between 31 May 2022 and 31 January 2023 from five European countries (Denmark, Italy, Romania, Spain and the UK). Participants The study involved 659 AF patients older than 18 years who were diagnosed with one or more concomitant chronic health conditions. Primary and secondary outcome measures The survey focused on identifying the needs and quality performance indicators (QPIs) of patients. Emotional engagement was evaluated using the Patient Health Engagement Scale (PHE-s), and cognitive-behavioural engagement was assessed using the Altarum Consumer Engagement Measure (ACE). Engagement scores of each measure were grouped as high or low and compared by age group, sex, level of education and country of recruitment, health-related quality of life, medication adherence and perception of care quality using χ 2 and Mann‒Whitney U tests (p<0.05). Results Among the 659 AF patients (70.9±10.2 years, 52.8% female), 428 (65%) were categorised as having high emotional PE levels based on PHE-s and were significantly more likely to be <75 years old and male, have a secondary level of education or above, and have <3 comorbidities (p<0.05). Regarding the ACE scores, 369 (56%) were classified as having high cognitive-behavioural PE levels and were more likely to be <65 years old, reside in Northern Europe, have degree-level education or higher, and have <3 comorbidities (p<0.05). Additionally, participants with high emotional PE demonstrated better quality of life, medication adherence and perceptions of quality of care, whereas those with higher levels of cognitive-behavioural PE had better quality of life and perceptions of quality of care. Conclusions From a clinical perspective, the findings highlight the need for a personalised approach sensitive to the expectations and needs of AF patients. The present research suggests that implementing sociodemographic and clinical profiling for AF patients could facilitate the formulation of improved care strategies.