# Assessment of comorbidity awareness in patients with atrial fibrillation: The ACAPAF study

## TL;DR

The study finds that patients with atrial fibrillation have moderate awareness of their comorbidities, and more education is needed to improve this awareness.

## Contribution

The study introduces the use of the EHRA-PATHS software for efficient comorbidity evaluation in atrial fibrillation patients.

## Key findings

- Patients' awareness of comorbidities like alcohol consumption and smoking is low.
- A single clinic visit and phone consultation do not significantly improve comorbidity awareness.
- The EHRA-PATHS software enables efficient comorbidity mapping in a reasonable time.

## Abstract

•Diabetes is a well-recognised comorbidity by patients with AF.•Alcohol consumption and physical inactivity are often underestimated and smoking underadmitted to the health care workers.•Patients’ comorbidity awareness is moderate.•More educational efforts than a single in-person session and additional phone consultation are needed for improve awareness.•The EHRA-PATHS software is a feasible tool for comorbidity evaluation in patients with AF within a reasonable time frame.

Diabetes is a well-recognised comorbidity by patients with AF.

Alcohol consumption and physical inactivity are often underestimated and smoking underadmitted to the health care workers.

Patients’ comorbidity awareness is moderate.

More educational efforts than a single in-person session and additional phone consultation are needed for improve awareness.

The EHRA-PATHS software is a feasible tool for comorbidity evaluation in patients with AF within a reasonable time frame.

Systematic and integrated comorbidity management in patients with atrial fibrillation (AF) requires patient involvement, starting with comorbidity awareness. This study evaluates comorbidity awareness in patients with AF before and after a first nurse-led AF clinic visit and after six months. We also measured the time needed for full comorbidity mapping using the EHRA-PATHS software.

This prospective two-centre study included patients diagnosed with AF attending the AF clinic for the first time. The software systematically assessed 23 comorbidities. Patients completed a comorbidity awareness questionnaire, focusing on nine AF-related comorbidities two weeks before their first visit, less than a week after, and six months later. Patients also had a telephone consultation with the AF nurse to discuss their comorbidities 1–3 months post-visit.

The study included 76 patients (mean age 68.3 ± 10.3 y). Baseline awareness of comorbidity relevance for AF ranged between 11.1–100.0 %. Awareness about own alcohol consumption was the most ‘underestimated’ comorbidity before first contact (50.0 %), while smoking was most ‘overestimated’ (55.6 %; i.e. admitted in private but not during formal evaluation by nurses). The impact of an AF clinic visit on awareness of personal comorbidities was limited (p = 0.456), and also after an additional phone consultation, awareness was suboptimal after six months (p = 0.099). AF nurses needed 18.4 ± 8.7 min to complete the software.

Patients’ comorbidity awareness is moderate, and more educational efforts are needed to improve their awareness. A systematic and complete comorbidity evaluation at the AF clinic using EHRA-PATHS software can be done within a reasonable time frame.