Planning Telehealth for Older Adults With Atrial Fibrillation in Rural Communities: Understanding Stakeholder Perspectives.

Older adults with atrial fibrillation (AF) in rural communities have less access to cardiac specialty care. Telehealth offers a viable approach to provide cardiac care, yet little is known about patients' and providers' views on telehealth's potential to support rural patients with AF. This qualitative descriptive study examines patient and health providers' perspectives, an important first step in planning a telehealth initiative. Eight patients with AF, along with one partner from rural communities, were recruited through an urban-based AF clinic. Five providers were recruited through professional practice leads in the health region. Semistructured telephone interviews were conducted with both stakeholder groups. The overriding theme was variability in patient and provider receptiveness to telehealth. Receptiveness reflected differences in past experience with telehealth, in perceived adequacy of rural health services, and in perceived gaps in AF care. These are important considerations in planning effective and sustainable telehealth in rural communities.

The Stressors and Coping Strategies of Older Adults With Persistent Atrial Fibrillation Prior to and Following Direct Current Cardioversion.

OBJECTIVE: The purpose of this study was to explore the stressors and coping strategies of older adults with persistent atrial fibrillation (AF) before and after direct current cardioversion. METHOD: The study used a qualitative descriptive design. Sixteen patients were recruited through an AF clinic to participate in individual interviews prior to the cardioversion and at 6 and 12 weeks post procedure. RESULTS: Pre-cardioversion, older adults experienced symptom and health care-related stressors superimposed on existing non-AF stressors. They used a range of emotion and problem-focused coping. Non-AF stressors increased post procedure at the same time that participants perceived less need for coping strategies with a return to regular rhythm. DISCUSSION: There was a shift from AF to non-AF related stressors following the cardioversion but a decrease in coping strategies. Older adults with AF should be encouraged to maintain use of coping strategies to manage ongoing stress and reduce the risk of AF recurrence.

Seeing the rural healthcare journeys of older adults with atrial fibrillation through a photographic lens.

Objectives Obtaining the voices of older adult patients with atrial fibrillation (AF) about their health and healthcare has become increasingly important in providing quality care. The purpose of this study was to understand the unique contributions of photographs in the healthcare journeys of rural living older adults with AF. Methods As part of a larger mixed methods study 10 older adults with AF living in rural communities were recruited through two rural primary care physicians' practices. They were followed over six months through a combination of face-to-face and telephone interviews. Photographs were submitted along with personal journey logs to report healthcare interactions. A photographic analysis was conducted. Results Collectively photos illuminated aspects of older adults AF journeys (stable, chronic unstable, and acute crisis) less explicit in the narrative accounts. Three themes emerged: focus of attention, life-space, and support. Shifts in illness as a focus of attention and life-space paralleled patients at different points in their AF journeys while a range of formal and informal supports were available to them. Discussion Photographs were valuable in shedding light on older adults' rural healthcare experiences. They offer a nuanced approach for gaining insights into the subtleties characterizing the journeys of older adults with AF.