Award Date

5-1-2020

Degree Type

Dissertation

Degree Name

Doctor of Nursing (ND)

Department

Nursing

First Committee Member

Mary Bondmass

Second Committee Member

Du Feng

Third Committee Member

Ju-Yeon Jo

Number of Pages

64

Abstract

Atrial fibrillation is the most common arrhythmia affecting over six million people; it is predicted to increase two-fold by the year 2050. This arrhythmia results in a lack of

atrial/ventricular communication, accompanied by ineffective atrial contraction, suboptimal ventricular filling, and thrombus formation. This may lead to stroke, and ultimately heart failure. The current economic burden related to the complications of atrial fibrillation is estimated to be greater than $6 billion annually with potentially catastrophic events, further increasing expenditure.

When patients experience symptoms related to atrial fibrillation, it is common for them to present to a hospital emergency department. These visits, many of which may not be necessary, can be costly and often are anxiety-provoking events. If a patient’s rhythm and rate can be managed virtually, via the Internet, patients’ anxiety may be decreased, satisfaction increased, and the use of costly resources reduced.

Available research suggests that management of atrial fibrillation via the Internet is a useful adjunct in reducing over-utilization of resources and improving the quality of life by decreasing anxiety. Moreover, with the addition of virtual visits, access to a cardiology provider is improved, thereby increasing patient satisfaction.

The purpose of this Doctor of Nursing Practice (DNP) project was to improve patient outcomes and reduce resource utilization related to atrial fibrillation. Over eight weeks, 43 patients meeting pre-determined criteria, were given a KardiaMobile® device and provided education on its use. This device is designed to pair with a mobile phone application, which is downloaded by the patient. The KardiaMobile® device transmits a 30-second cardiac rhythm strip, equivalent to Lead I on a traditional 12-lead electrocardiogram, converted to pdf format, then emailed to a provider for review. Using the treatment algorithm developed by this DNP student, coupled with the clinical judgment of symptomatology, episodic management commenced with a phone call or a virtual ‘face-to-face’ visit.

There was no statistical significance demonstrated in pre- and post- HADS scores for anxiety or depression; however, the results of the internal satisfaction survey revealed a reduction in self-reported anxiety and increased satisfaction with the ability to communicate with the healthcare team and improved access to a cardiology provider. Lastly, patients felt this program reduced unnecessary ER visits and felt empowered to manage their healthcare concerns. The implications of this project also extended to rural areas, where nearby acute care facilities are not available, thereby improving patient outcomes.

Keywords

Anxiety; Atrial fibrillation; Innovative technology; Mobile application; Smartphone technology; Telemonitoring

Disciplines

Health and Medical Administration | Medical Sciences | Medicine and Health Sciences | Nursing

File Format

pdf

File Size

1.7 MB

Degree Grantor

University of Nevada, Las Vegas

Language

English

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

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