Open Access Open Access  Restricted Access Subscription Access

The Diverse Journeys of Rural Older Adults with Atrial Fibrillation

Kathy L Rush, Nelly D Oelke, Matt Shay, Robert C Reid


Rationale, aims and objectives: Atrial fibrillation (AF) is a serious chronic heart condition characterized by an irregular, rapid heartbeat and unpredictable course. Patients with AF often struggle with managing the impact of the disease on daily activities.  Afflicted rural dwelling patients face added challenges including inequities in health services and a lack of cardiac specialty services. AF patient journeys through the healthcare system have not been well documented, but offer a valuable tool for improving patient management and outcomes. The purpose of this study was to document individual AF patient journeys of rural living older adults.

Method: This study used a 6-month longitudinal design to examine the rural healthcare experiences of 10 AF patients. AF patient journeys were mapped using information gathered through interviews, written logs, photographs and an electronic health record review. Thematic analysis was used in clustering common features of the healthcare journeys of older adult patients with AF and a typology developed to describe them. 

Results: Each patient’s journey with AF was unique. Symptom and disease severity, health service utilization and needs emerged as differentiating features in the identification of 3 journey types: (1) Stable, (2) Chronically Unstable and (3) Acute Crisis.

Conclusions: These journey types provide a valuable person-centered tool to assess patient needs at any point in the AF trajectory and to address salient risks that accompany each type to improve management of the increasing number of persons suffering from AF.


Atrial fibrillation, cardiac, health service delivery, integrated services, older adults, patient journey, person-centered healthcare, risk evaluation, rural, self-management

Full Text:



Nanton, V., Docherty, A., Meystre, C. & Dale, J. (2009). Finding a pathway: Information and uncertainty along the prostate cancer patient journey. British Journal of Health Psychology 14, 437-458.

Manchaiah, V.C., Stephens, D. & Meredith, R. (2011). The patient journey of adults with hearing impairment: the patients' views. Clinical Otolaryngology: Official Journal Of ENT-UK; Official Journal Of Netherlands Society For Oto-Rhino-Laryngology & Cervico-Facial Surgery 36 (3) 227-234.

Jackson, K., Oelke, N.D., Besner, J. & Harrison, A. (2012). Patient Journey: Implications for Improving and Integrating Care for Older Adults with Chronic Obstructive Pulmonary Disease. Canadian Journal on Aging 31 (2) 223-233.

Momen, N., Kendall, M., Barclay, S. & Murray, S. (2013). Using timelines to depict patient journeys: a development for research methods and clinical care review. Primary Health Care Research and Development 14 (4) 403-408.

Crepaz, M. & Curry, J.M. (2013). Improving the cancer patient journey. Studies in Health Technology & Informatics. In H. Grain and L.K. Schaper (Eds.) Health Informatics: Digital Health Service Delivery - The Future is Now! Doi:10.3233/978-1-61499-266-0-14

Oliver, S. (2008). Exploring the healthcare journey of patients with rheumatoid arthritis: A mapping project - implications for practice. Musculoskeletal Care 6 (40) 247-266.

Martin, C.M., Grady, D., Deaconking, S., McMahon, C., Zarabzadeh, A. & O’Shea, B. (2011). Complex adaptive chronic care - typologies of patient journey: a case study. Journal of Evaluation in Clinical Practice 17, 520-524.

Baron, S. (2009). Evaluating the patient journey approach to ensure health care is centered on patients. Nursing Times 105 (22) 20-23.

Johnson, E.C., Horwood, J. & Gooberman-Hill, R. (2014). Patients’ Journeys through Total Joint Replacement: Patterns of Medication Use. Musculoskeletal Care 12, 92-102.

Fitzmaurice, D.A, Hobbs, F.D.R., Jowett, S., Mant, J., Murray, E.T., Holder, R., Raftery, J.P., Bryan, S., Davies, M., Lip, G.Y.H. & Allan, T.F. (2007). Screening versus routine practice for detection of atrial fibrillation in people aged 65 or over: cluster randomised controlled trial. British Medical Journal 335, 383-386.

Marini, C., De Santis, F., Sacco, S., Russo, T., Olivieri, L., Totaro, R. & Carolei, A. (2005). Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: Results from a population-based study. Stroke 36 (6) 1115-1119.

Kato, T., Yamashita, T., Sagara, K., Linuma, H. & Fu, L.T. (2004). Progressive nature of paroxysmal atrial fibrillation. Observations from a 14-year follow-up study. Circulation Journal 68, 568-672.

McCabe, P.J., Schumacher, K. & Barnason, S.A. (2011). Living with atrial fibrillation: A qualitative study. Journal of Cardiovascular Nursing 26 (4) 336-344.

McCabe, P.J., Schad, S., Hampton, A. & Holland, D.E. (2008). Knowledge and self-management behaviors of patients with recently detected atrial fibrillation. Heart & Lung - the Journal of Acute and Critical Care 37 (2) 79-90.

Wong, S. & Regan, S. (2009). Patient perspectives on primary care in rural communities: effects of geography on access, continuity and efficiency. Rural and Remote Health 9, 1142 (Online).

Dandy, K. & Bollman, R.D. (2009). Seniors in Rural Canada. Ottawa, ON: Statistics Canada.

Statistics Canada. (2011). From urban areas to population centres. Retrieved March 15, 2015 from:

Katz, S., Down, T.D., Cash, H.R. & Grotz, R.C. (1970). Progress in the development of the index of ADL. The Gerontologist 10 (1) 20-30.

Lawton, M.P. & Brody, E.M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist 9 (3) 179-186.

Borson, S., Scanlan, J., Brush, M., Vitallano, P. & Dokmak, A. (2000). The Mini-Cog: A cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry 15 (11) 1021-1027.

Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M.B. & Leirer, V.O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research 17, 37-49.

Spertus, J., Dorian, P., Bubien, R., Lewis, S., Godejohn, D., Reynolds, M. & Burk, C. (2011). Development and validation of the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Questionnaire in patients with atrial fibrillation. Circulation. Arrhythmia and Electrophysiology 4 (1) 15-25.

Richards, L. & Morse, J.M. (2013). Readme First for User’s Guide to Qualitative Methods (3rd Edn). Thousand Oaks: Sage Publications.

Bosch, R.F., Kirch, W., Theuer, J-D., Pittrow, D., Kohlhaußen, A., Willich, S.N. & Bonnemeier, H. (2013). Atrial fibrillation management, outcomes and predictors of stable disease in daily practice: Prospective non-interventional study. International Journal of Cardiology 167, 750-756.

Surate Solaligue, D.E., Hederman, L. & Martin, C.M. (2014). What weekday? How acute? an analysis of reported planned and unplanned GP visits by older multi-morbid patients in the patient journey record system database. Journal of Evaluation in Clinical Practice 20 (4) 522-526.

Bengtson, L.G.S., Lutsey, P.L., Loehr, L.R., Kucharska-Newton, A., Chen, L.Y., Chamberlain, A.M., Wruck, L.M., Duval, S., Stearns, S.C. & Alonso, A. (2014). Impact of Atrial Fibrillation on Healthcare Utilization in the Community: The Atherosclerosis Risk in Communities Study. Journal of the American Heart Association 3, e001006.

Tu, K., Gong, Y., Austin, P.C., Jaakimanian, L., Tu, J.V. & the Canadian Cardiovascular Outcomes Research Team (2004). An overview of the types of physicians treating acute cardiac conditions in Canada. Canadian Journal of Cardiology 20 (3) 282-291.

Lindsberg, P.J., Toivonen, L. & Diener, H-C. (2014). The atrial fibrillation epidemic is approaching the physician’s door: will mobile technology improve detection? BMC Medicine 12, 180.



  • There are currently no refbacks.