A glass half-full: physical activity discussions between healthcare providers and patients with atrial fibrillation

Abstract Background Atrial fibrillation (AF) is the most common cardiac arrhythmia and can result in debilitating symptoms (e.g., poor exercise tolerance, fatigue, palpitations). Strong evidence suggests that regular physical activity (PA) can ameliorate such findings in patients with AF by reducing AF recurrence, and symptom severity and improving functional capacity, health-related quality of life, and heart-rate control. The 2020 Canadian Cardiovascular Society (CCS) Guidelines for the management of AF are the first anywhere to include specific PA targets (≥200 minutes/week of moderate intensity PA, 2-3 days/week of resistance training, and if 65 years of age, 10 minutes/day of flexibility training 2 days/week). However, despite the advantageous responses that follow PA and the inclusion of PA in AF management guidelines, the degree to which PA-related discussions occur between patients with AF and their cardiologists, physicians, or other healthcare providers (HCPs) was unknown. Purpose The primary purpose of this observational study was to assess whether cardiologists, family physicians, or HCPs are discussing PA with their patients with AF. The secondary purpose was to explore specific PA recommendations, any referrals to address PA, and sex-based variations in PA discussions. Methods Patients attending an AF management appointment at a large, Canadian tertiary cardiovascular centre were recruited to have their electronic medical records reviewed for documentation of PA discussions with their cardiologist. Patients also completed a questionnaire assessing whether PA discussions occurred with their cardiologist, family physician, or another HCP, and whether they received specific PA recommendations or referrals. Results A total of 195 patients with AF (35.4% female) participated. Half of the patients reported having no PA discussion with their cardiologist (49%). Of those who did report such a discussion, no documentation of the discussion was found in the medical records of 22%. A third of patients (32%) reported not discussing PA with their family physician, and two thirds (62%) reported no PA discussions with other HCPs. Most patients (50-71%) did not receive specific PA recommendations (frequency, intensity, time, and type) from their cardiologist or family physician. Few patients reported being referred to a PA specialist or rehabilitation program by any HCP (15%). Females were provided frequency recommendations (i.e., how often to engage in PA) more often than males by cardiologists (X²=5.256, p=0.022), family physicians (X²=6.933, p=0.008), and other HCPs (X²=5.188, p=0.023). Conclusion Limited PA discussions are occurring between patients with AF and their HCPs suggesting that patients with AF are not receiving important, relevant information about PA in clinical settings. This is a missed opportunity for incorporating the well-established health benefits of PA in the care of those with AF.