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.‬ ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬