Introduction
Atrial fibrillation (AF) is the most common dysrhythmia, affecting 3.5
million people worldwide, and is associated with an increased risk for
stroke.1 AF is a progressive condition that involves
medical management such as rate control, rhythm control, and
anti-coagulation, as well as lifestyle change and self-management
behaviors.2,3 AF is also associated with significant
psychologic distress, particularly for patients who are symptomatic,
perceive AF to be dangerous, or have low AF health
literacy4; research to date suggests high rates of
anxiety and depression, 35% and 20%, respectively, in AF
samples.5 Daily management of AF involves adherence to
medical therapies (e.g rate/rhythm control, stroke prophylaxis),
management of comorbidities, abstinence from smoking, avoiding alcohol
consumption, and sustaining regular physical
activity.6 Collectively, the psychological and
behavioral aspects of coping with and managing AF contribute to the key
outcomes of symptom reduction and quality of
life.7,8,9,10,11
Current research approaches have generally relied on quality of life
measures to capture the entirety of the patient experience. For example,
the Atrial Fibrillation Effect on Quality-of-life (AFEQT) questionnaire
was developed to explicitly measure patients’ perceptions of their
symptoms, functional impairment, treatment concerns, and satisfaction
with treatment.12 The reliance on QOL measures to
capture the totality of the patient experience focuses on the desired
endpoint(s), but may overlook possible process and intervention targets
such as: self-assessment, self-care maintenance, management, and
confidence that have demonstrated value in heart failure
treatment.13,14 The development of a patient
confidence measure for AF patients may broaden the lens for examination
of the patient experience and provide additional understanding and
targets for intervention. The purpose of this study was to test the
reliability and validity of a stand-alone measure of confidence in
self-management of AF, the C onfidence in A trial
FibriL lation Management (CALM) scale.