Assessment of Patient and Physician Education on Medical Adherence and Avoidance of Hospitalisation in Atrial Fibrillation

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias, and its global prevalence is increasing, presenting a substantial burden to healthcare systems. This thesis analyses the impact of patient education, lifestyle changes, and clinical practices on the management of AF, with the objective of finding factors that affect patient outcomes and resource utilisation. It employs a mixed-methods approach, comprising a prospective cohort service evaluation survey assessing the impact of patient education on hospitalisations and medication adherence, and a crosssectional audit among cardiology physicians using a structured questionnaire to assess clinical practices and educational strategies. The study underscores the significance of patient education in diminishing hospital admissions, revealing that patients who were informed about controlling irregular heartbeat events exhibited markedly reduced hospitalisation rates (11.76%), in comparison to those who were not informed (47.05%). Nonetheless, a significant percentage of cardiology physicians (42.59%) failed to provide educational leaflets to newly diagnosed AF patients, indicating a deficiency in standardised care. The study also reveals differences in patient awareness, especially with lesser-known risk factors including inadequate sleep, with only 41.17% of patients recognising it as contributing to AF. Lifestyle alterations, such as smoking cessation and decreased alcohol intake, displayed having a small impact on patient outcomes, including admissions to hospital. Hence, the study could not establish a meaningful correlation between lifestyle changes and hospital re-admissions. Anticoagulant medication adherence was reported at 94.11%, while physician practices regarding compliance monitoring varied, with 19.05% of physicians not performing regular adherence assessments. The study examines preferences towards anticoagulants, revealing a distinct inclination towards apixaban owing to its advantageous pharmacological characteristics, over Vitamin K Antagonists (VKAs). The results indicate that although existing AF care regimens are beneficial, there is considerable potential for enhancement in patient education, the uniformity of clinician practices, and the incorporation of lifestyle interventions. The study advocates for the establishment of defined instructional methods, improved adherence monitoring, and personalised treatment strategies to maximise patient outcomes and healthcare resource distribution. This thesis contributes to the ongoing efforts to improve the management of AF and provides a foundation for future research in the field.