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69/Patient and public involvement (PPI): a route to high-quality research in atrial fibrillation

Published Online: October 3rd 2021 European Journal of Arrhythmia & Electrophysiology. 2021;7(Suppl. 1):abstr69
Authors: I Kanella (Presenting Author) - Imperial College London, London; C Coyle - Hammersmith Hospital, London; P Kanagaratnam - Hammersmith Hospital, London
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Background: PPI can improve the quality of research and strengthen health outcomes. It is increasingly a prerequisite for funding support. AF affects 43.6 million individuals globally posing a significant burden to patients and physicians. In view of the recent ESC guidelines for AF, incorporating patient insight in clinical research could optimise management outcomes.

Purpose: After identifying a gap in literature for PPI research in AF we aimed to understand patient priorities for:
• Preferred AF management strategies
• Research
• Willingness to participate in research
• Preferred end-points to measure treatment success.

Methods: We conducted a rapid response survey in an opportunistic cohort of 50 patients with AF who had undergone or awaited an AF ablation at our institution. A quantitative analysis was performed. Qualitative data was collected through 18 semi-structured interviews with a part of the sample, and interpreted with thematic analysis.

Results: 50 patients (male: 58%, mean age: 70 ± 10.74 years) with a history of symptomatic AF participated in the survey. 42 (84%) were treated with medication and 39 (78%) at least one catheter ablation. AF ablation was identified as a management priority. Patients perceived that ablation improves quality of life (QoL) and reduces AF burden significantly compared to cardioversion and anti-arrhythmic drug therapies (AADs) which were associated with short-lived effects. 34 patients (68%) felt the ~60% success rate for AF ablation is not adequate and so improvement is a research priority (n=47, 94%). 46 patients (92%) were willing to participate in catheter ablation research. 21 patients (42%) prefer to undergo one procedure (experimental or control arm) to minimise harm from additional ablation, and 26 (58%) both procedures at the same event. To assess efficacy of AF treatment, 43 patients (86%) favoured rhythm monitoring compared to a QoL validated assessment tool. However, all patients interviewed (n=18) felt patient reported outcomes (PROs) such as emotional and cognitive functioning are important when assessing efficacy.

Conclusions: Catheter ablation is a management priority for patients. The latest ESC guidelines reflect patient desires by considering ablation as a first-line treatment. Patients steer AF research objectives towards improving the success rate of catheter ablation which is currently considered insufficient. Both PPI research and ESC guidelines underline the important of a holistic approach in assessing the impact of AF by prioritising patient reported outcomes in assessing treatment success. PPI has highlighted the need for further work improving AF ablation techniques by developing a patient-tailored approach.

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