The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy

Dorian, Paul; Jung, Werner; Newman, David; Paquette, Miney; Wood, Kathryn A.; Ayers, Gregory M.; Camm, John; Akhtar, Masood; Lüderitz, Berndt

doi:10.1016/s0735-1097(00)00886-x

Cited by 544 publications

(386 citation statements)

References 18 publications

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“…The AFSS (Atrial Fibrillation Severity Scale)1 was used to quantify symptom severity at baseline. This self‐administered questionnaire includes an instrument to measure the presence and severity of individual symptoms attributable to AF over a 4‐week recall period, with 7 individual symptoms, including palpitation frequency, dyspnea, fatigue, and exercise intolerance, quantified on 5‐point Likert scales and higher values reflecting more‐severe AF symptoms (AFSS symptom score).…”

Section: Methodsmentioning

confidence: 99%

“…The negative impact of atrial fibrillation (AF) on health‐related quality of life (hrQOL) has been extensively documented,1 with several studies also demonstrating that AF patients may experience significant symptoms of anxiety and depression,2, 3 that themselves may impact on AF symptom severity and hrQOL 4. Other data have indicated that enduring aspects of personality, including stress perception3 and personal negativity,5 may be important to the subjective experience of AF.…”

Section: Introductionmentioning

confidence: 99%

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Psychological Distress and Suicidal Ideation in Patients With Atrial Fibrillation: Prevalence and Response to Management Strategy

Walters

Wick

Tan

et al. 2018

JAHA

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BackgroundAn association between atrial fibrillation (AF), anxiety, and depression is recognized, but the spectrum of psychological distress remains unclear. We aimed to characterize the severity and predictors of distress associated with AF in a tertiary population and its response to AF management.Methods and ResultsSeventy‐eight patients with symptomatic AF underwent evaluation, including of AF symptom severity, health‐related quality of life, psychological distress, suicidal ideation, and specific personality traits. Twenty participants underwent AF ablation and 58 were managed medically, with repeat assessments at 4, 8, and 12 months. Severe distress (Hospital Anxiety and Depression Scale score, ≥15/42) was identified in 27 of 78 (35%). Independent predictors were a personality marked by vulnerability to stress (Perceived Stress Scale: R 2, 0.54; β=0.7±0.1; t=7.8; P<0.001) and 1 marked by negativity/social inhibition (Type D Personality Scale: R 2, 0.47; β=0.7±0.1; t=6.7; P<0.001). Suicidal ideation was reported by 16 of 78 (20%) and was predicted by personality traits (Perceived Stress Scale score: R 2, 0.35; odds ratio, 1.22±0.06; P<0.001; Type D Personality Scale score: R 2, 0.48; odds ratio, 1.43±0.14; P<0.001). Effective AF ablation (median AF burden 1% [0–1%] over 12 months) was associated with significant reductions in distress (Hospital Anxiety and Depression Scale score, 13.9±1.8 to 4.3±1.8; P<0.05) and prevalence of suicidal ideation (30–5%; P=0.02).ConclusionsThere was a high prevalence of severe psychological distress (35%) and of suicidal ideation (20%) in a tertiary AF population, with personality traits predicting both. Effective AF ablation was associated with significant improvements, suggesting AF itself may be a treatable causative factor of distress.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Psychological Distress and Suicidal Ideation in Patients With Atrial Fibrillation: Prevalence and Response to Management Strategy

Walters

Wick

Tan

et al. 2018

JAHA

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“…46 Finally, AF causes a wide variety of symptoms, including fatigue and reduced exercise tolerance, and significantly impairs quality of life (QOL). 47 It is notable that asymptomatic status is associated with similar (or worse) prognosis compared with symptomatic status. 48 AF is also important when considered in terms of use of health care resources and cost.…”

Section: Section 2: Definitions Mechanisms and Rationale For Af Ablmentioning

confidence: 99%

“…47,63,1088 These measures can provide a more global reflection of symptom change, symptomatic arrhythmia burden, and the difference between actual and desired health and function than more focused endpoints of rhythm status at specific points in time. Generic tools, such as the SF-36 health survey, 1089 which is applicable to a broad range of disease states and health conditions, and disease-specific questionnaires 1090, 1091 developed to assess symptom burden in patients with arrhythmias, have been most widely employed.…”

Section: Outcomes Of Af Ablation In Populations Not Well Represented mentioning

confidence: 99%

“…47,1088,1092 A number of single-center, nonrandomized observational studies of AF ablation have demonstrated significant and sustained improvements in QOL scores following catheter ablation. 63,1088 Taken alone, these findings need to be interpreted cautiously, because in the absence of a comparison group or treatment blinding, placebo effects cannot be excluded.…”

Section: Outcomes Of Af Ablation In Populations Not Well Represented mentioning

confidence: 99%

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2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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1,468

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Effect of Weight Reduction and Cardiometabolic Risk Factor Management on Symptom Burden and Severity in Patients With Atrial Fibrillation

Abed¹,

Wittert²,

Leong³

et al. 2013

JAMA

663

402

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IMPORTANCE Obesity is a risk factor for atrial fibrillation. Whether weight reduction and cardiometabolic risk factor management can reduce the burden of atrial fibrillation is not known. OBJECTIVE To determine the effect of weight reduction and management of cardiometabolic risk factors on atrial fibrillation burden and cardiac structure. DESIGN, SETTING, AND PATIENTS Single-center, partially blinded, randomized controlled study conducted between June 2010 and December 2011 in Adelaide, Australia, among overweight and obese ambulatory patients (N = 150) with symptomatic atrial fibrillation. Patients underwent a median of 15 months of follow-up. INTERVENTIONS Patients were randomized to weight management (intervention) or general lifestyle advice (control). Both groups underwent intensive management of cardiometabolic risk factors. MAIN OUTCOMES AND MEASURES The primary outcomes were Atrial Fibrillation Severity Scale scores: symptom burden and symptom severity. Scores were measured every 3 months from baseline to 15 months. Secondary outcomes performed at baseline and 12 months were total atrial fibrillation episodes and cumulative duration measured by 7-day Holter, echocardiographic left atrial area, and interventricular septal thickness. RESULTS Of 248 patients screened, 150 were randomized (75 per group) and underwent follow-up. The intervention group showed a significantly greater reduction, compared with the control group, in weight (14.3 and 3.6 kg, respectively; P < .001) and in atrial fibrillation symptom burden scores (11.8 and 2.6 points, P < .001), symptom severity scores (8.4 and 1.7 points, P < .001), number of episodes (2.5 and no change, P = .01), and cumulative duration (692-minute decline and 419-minute increase, P = .002). Additionally, there was a reduction in interventricular septal thickness in the intervention and control groups (1.1 and 0.6 mm, P = .02) and left atrial area (3.5 and 1.9 cm 2 , P = .02). CONCLUSIONS AND RELEVANCE In this study, weight reduction with intensive risk factor management resulted in a reduction in atrial fibrillation symptom burden and severity and in beneficial cardiac remodeling. These findings support therapy directed at weight and risk factors in the management of atrial fibrillation.

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The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy

Abstract: Quality of life is as impaired in patients with intermittent AF as in patients with significant structural heart disease. Patients' perception of QoL is not dependent on the objective measures of disease severity that are usually employed.

Cited by 544 publications

References 18 publications

Psychological Distress and Suicidal Ideation in Patients With Atrial Fibrillation: Prevalence and Response to Management Strategy

Psychological Distress and Suicidal Ideation in Patients With Atrial Fibrillation: Prevalence and Response to Management Strategy

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Effect of Weight Reduction and Cardiometabolic Risk Factor Management on Symptom Burden and Severity in Patients With Atrial Fibrillation

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