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UBC Theses and Dissertations

The pre-diagnosis symptom experience of patients with atrial fibrillation Wilson, Ryan


Atrial Fibrillation (AF) is the most common arrhythmia worldwide, with five million new cases diagnosed every year. If left untreated, AF significantly increases the risk of stroke, heart failure, and death. Despite the increasing prevalence of AF, little is known about the symptom experiences of patients prior to receiving their AF diagnosis, and the influence of these experiences on health care seeking. Therefore, the purpose of this interpretive descriptive study was two-fold: i) to explore the pre-diagnosis AF symptom experience of adults ≥ 19 years of age; and ii) to examine the influence of age, and gender on the AF symptom experience. Eligible participants were recruited from outpatient AF clinics and a cardiac rehab centre. Consenting adults (n=26) with newly diagnosed AF participated in semi-structured interviews that accessed their pre-diagnosis symptom experience and specifically their perceptions, evaluations, and responses to their symptoms. Participants’ pre-diagnosis symptom experience was highly complex involving interconnected perceptions, evaluations and response to symptoms following the onset of AF. Perception involved participants’ variable awareness of bodily sensations (changes) from imperceptible noticing to commanding attention, with rest and activity heightening symptom awareness. Evaluation reflected participants’ intense cognitive work of judging, making sense of, and finding explanations for their bodily sensations and symptoms. In evaluating symptoms participants formed personal theories, gathered evidence to support/refute their theories, and re-theorized disrupted theories. Responses represented the actions/activities employed, in responding to, and dealing with their symptom(s). Dominant responses included: non-treatment, self-treatment, and health seeking; responding with non-treatment and self-treatment protracted the pre-diagnosis time, with periods lasting from weeks to years. Gender, age (≤ 67 vs ≥ 68 years), and the timing of AF diagnosis (early or late) played important roles in participants’ symptom experiences. Women experienced greater symptom severity than men, yet were more inclined to dismiss their symptoms, to perceive lower AF risk, to prioritize caregiving responsibilities over attending to their health, and reported frustration and anger with their physicians associated with diagnosis delays. This research offers key insights into how gender and age influence the symptom experience, and highlights the importance of clinicians accounting for these differences in practice, to minimize the pre-diagnosis time.

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