Date of Award

1-1-2012

Document Type

Campus Access Dissertation

Department

College of Nursing

Sub-Department

Nursing Practice

First Advisor

Joan Culley

Second Advisor

JoAnne Herman

Abstract

Atrial fibrillation (AF) is a chronic illness that can diminish the quality of life (QoL) of community dwelling older adults. This can be due to associated symptoms, side effects from treatment, changes in functional capacity, and disruption in role performance. Current AF management guidelines recommend rate versus rhythm control based upon the presence or absence of symptoms and patient preference. Many patients continue to present with AF related complaints despite optimal therapy suggesting a superior evaluation and management strategy. QoL was examined in several AF clinical trials comparing rate and rhythm control as an outcome for measurement of treatment success. The purpose of this evidence based practice project is to answer the question: 'In community-dwelling adults age 65 and over with atrial fibrillation (AF), is rhythm control superior to rate control in improving quality of life?' A search was completed on 8 online databases using keywords `atrial fibrillation' and `quality of life.' Also, a practice evaluation project was conducted to compare to literature findings. The literature review showed that AF patients have a worse QoL compared to age-matched healthy controls. QoL improved with both rate and rhythm control methods. One strategy was not clearly superior to the other. The practice evaluation project revealed a significant moderate correlation between an increasing total symptom burden and a lower reported quality of life. Patients in both treatment strategies reported comparable QoL scores. Symptomatic AF patients and those with congestive heart failure had a poorer QoL overall. Fatigue and dizziness were significant predictors of a poor VAS QoL score in addition to the total symptom burden. Further research is needed to develop AF specific quality of life measurement tools that are quick and easy to implement into clinical practice and provide an accurate QoL picture.

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