Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Disease awareness and knowledge of risk factors for stroke and atrial fibrillation in a cardiology practice cohort
D. Engler1, L. Bauer1, J. Brederecke1, A. Ohlrogge1, S. Camen1, C. S. Börschel1, S. Blankenberg2, R. Schnabel1
1Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 2Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH, Hamburg;

Aims and Background

Disease awareness is key for the uptake of preventive measures and positively affects self-management of atrial fibrillation (AF) patients or individuals with an increased risk of AF. However, information on patients’ subjective risk awareness is lacking. This study aimed to identify the predictors of incorrect subjective risk estimation to guide future targeted public health information.

Method

In a prospective cardiology practice cohort (N=1200; mean age= 59.6 years; women 34.4%) with a follow-up of 2.7 years we assessed the subjective estimation for: 1) the risk of stroke and AF in patients with an increased risk of AF (N=292) and 2) the stroke risk of AF patients (N=447). We used a 4-point Likert scale to measure the subjective risk estimation and matched the results according to established risk scores and classified participants as “over”, “under” and “correct” estimators. For individuals without AF we calculated the risk of incident AF using the CHARGE-AF Score and the risk of stroke using a revised Framingham risk score to predict the 10-year probability of stroke. In AF patients we assessed their self-estimated risk of stroke compared to the CHA2DS2-VASc Score.

We performed bivariate association analyses of risk factors with over- or underestimation for stroke and AF with reference to correct estimators. Tests for trend were performed using a non-parametric Cuzick test.

Results

At baseline 52 AF patients (10.6%) and 53 non-AF patients (17.6%) indicated that they cannot estimate their own stroke risk and thus, were incapable to estimate their own risk of stroke. This also applied to 97 non-AF patients (27.8%) that did not estimate their AF risk.

AF patients who underestimated their own stroke risk were significantly older (65.2 vs 59.8 years; p <.0001), less frequently men (33.3% vs 44.4 %; p=0.023), had lower body weight (85.3 kg vs 82.5 kg p=0.023), fewer previous strokes (15.1% vs 8.3%; p= 0.002) and had a higher chronic disease burden such as diabetes, hypertension, heart failure and coronary heart disease compared to AF patients with correct estimation.

Individuals without AF history at baseline estimated their AF risk (r = .216; z = -4.7; p < 0.001) and the stroke risk (r=.263; z = -6,359; p >.0001) significantly higher than their current risk to develop the disease while the AF risk estimation (r=.216; z = -1.7; p=0.098) and the stroke risk estimation (r=0.035; z =-0.743; p=0.458) was comparable to the score assessments in the follow-up. AF patients estimated their stroke risk significantly higher than their current risk (r= .125; z = -3.7; p <.001). This observation was similar during follow-up (r=.105; z = -3.214; p <.001).

Conclusions

Only the minority of the participants in our study cohort correctly estimated their own risk to develop AF and/or a stroke, half of the participants overestimated their own risk profile. The study identified several predictors related to the awareness and the knowledge of the disease and the data highlights the need for more explicit educational programs to improve AF disease awareness.




https://dgk.org/kongress_programme/jt2022/aP1824.html