Older individuals’ need for knowledge and follow‐up about their chronic atrial fibrillation, lifelong medical treatment and medical controls

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Older people constitute the fastest growing proportion of the population in the industrialised world, and the expected demographic development shows that Sweden has the world's largest amount of older people in total population 1. With age, the body goes through changes that make it more vulnerable to diseases. Diagnoses of cardiovascular diseases (CVDs) are increased in the older population and have grown to be one of the leading causes of death in all countries. Among CVDs, arrhythmia is a common condition, and the most frequently occurring arrhythmia is chronic atrial fibrillation (AF) 2. Approximately 50% of those with chronic AF are 75 years or older 3. In Sweden alone, chronic AF is expected to occur in about 300 000 people 4. AF is a major cause of morbidity and mortality, increasing risks for death, congestive heart failure (CHF) 4, and as chronic AF is characterised by electrical chaos in the atrium, it can result in a risk of thrombus, which can break off in the vascular system and cause serious damage in, for instance, the brain 5. In order to reduce blood clotting and prevent thromboses, lifelong medical treatment with vitamin K antagonists – oral anticoagulation (OAC), is regularly used. These medications often require many sacrifices from the person taking them 6 which includes regular clinic visits, restrictions on diet and alcohol intake, anxiety regarding bleeding and drug interactions, and impact on career, dependents and social life 7. Today, Warfarin® is one of the most common OAC medicines in Sweden. This treatment involves a fine balance between the benefits (protection against blood clots and stroke) and risks (side effects such as serious and sometimes life‐threatening bleeding) 8. Treatment with Warfarin® also requires that the person is monitored regularly so that the dose is adjusted to provide maximum efficacy and minimise the risk of side effects. This control of Warfarin® therapy is done by laboratory testing to monitor international normalised ratios (INRs) of prothrombin time (PK tests) and in Sweden handled by specialised clinics (AK clinics) or in primary health care 8. In these contexts, the patient does not usually meet physicians and nurses specialised in arrhythmias. Individuals with chronic AF often feel psychologically unwell (6, 7) as well as physical symptoms. Furthermore, living with chronic AF affects several dimensions of the individual's life, and it also requires fundamental adjustments for the individual such as making lifestyle changes, and putting the new life situation into context and meaning 7. Studies, conducted about quality of life among people living with AF, using quantitatively methods with instruments like SF‐36, have been done earlier. They are showing that persons with AF experience worse health‐related quality of life (HRQL) compared with healthy individuals 9 and 10. The fact that these older persons have a chronic condition, with negative impact on life, implies that many individuals with chronic AF suffer over longer periods of time. This enhances the importance of qualitative studies designed to increase awareness and obtain a deeper understanding of individual experiences.
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