Identifying and understanding the care pathway of patients with atrial fibrillation in Brazil and the impact of the COVID-19 pandemic: A mixed-methods study

Atrial fibrillation (AF) is a major risk factor for stroke. To enable improvements to AF diagnosis and follow-up care, understanding current patient pathways and barriers to optimal care are essential. We investigated the patient care pathways and their drivers, and the impact of the COVID-19 pandem...

Full description

Saved in:
Bibliographic Details
Published in:PloS one 2023-10, Vol.18 (10), p.e0292463-e0292463
Main Authors: Goulart, Alessandra C, Varella, Ana C, Gooden, Tiffany E, Lip, Gregory Y. H, Jolly, Kate, Thomas, G. Neil, Lotufo, Paulo A, Greenfield, Sheila, Olmos, Rodrigo D, Bensenor, Isabela M, Manaseki-Holland, Semira
Format: Article
Language:English
Subjects:
Anticoagulants
Atrial fibrillation
Availability
Cardiac arrhythmia
Cardiology
Care and treatment
Content analysis
COVID-19
Data collection
Diagnosis
Earth Sciences
Electrocardiography
Emergency medical services
Fibrillation
Health care
Health care facilities
Health risks
Hospitals
Medical care, Cost of
Medical research
Medicine and Health Sciences
Medicine, Experimental
Methods
Mixed methods research
Pandemics
Patient outcomes
Patients
People and places
Physicians
Primary care
Public awareness
Qualitative analysis
Questionnaires
Risk factors
Social Sciences
Statistical analysis
Stroke
Stroke (Disease)
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Atrial fibrillation (AF) is a major risk factor for stroke. To enable improvements to AF diagnosis and follow-up care, understanding current patient pathways and barriers to optimal care are essential. We investigated the patient care pathways and their drivers, and the impact of the COVID-19 pandemic on patient pathways in a middle-income country setting, Brazil. This mixed-methods study in São Paulo, included adults ([greater than or equal to]18y) with AF from 13 primary/secondary healthcare facilities. Surveys using baseline, follow-up (administered [greater than or equal to]two months after baseline) and COVID-19 questionnaires (quantitative), and three focus group discussions (FGDs) were conducted. Minimum sample size for the quantitative component was 236 and we aimed to reach saturation with at least three FGDs for the qualitative component. Descriptive statistics were used for quantitative data and a content analysis was used for qualitative data to identify themes related to AF diagnosis and follow-up care. 267 participants completed the baseline questionnaire: 25% were diagnosed in primary care, 65% in an emergency or inpatient department. At follow-up (n = 259), 31% visited more than one facility for AF care, and 7% had no follow-up. Intervals between international normalised ratio (INR) tests were increased during the pandemic, and the number of healthcare visits and availability of medication were reduced. Seventeen patients participated in three FGDs and revealed that AF diagnosis often occurred following a medical emergency and patients often delay care-seeking due to misconceptions about AF symptoms. Long waiting times, doctor/patient interactions and health system factors, such as doctor availability and the referral system, influence where participants visited for follow-up care. Lack of public awareness and underdeveloped primary healthcare lead to delayed diagnosis, which impacts clinical outcomes and excess patient and healthcare system costs. Health system, care-provider, and pandemic factors disrupt timely and effective continuity of care.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0292463