Psychopathology and Symptoms of Atrial Fibrillation
Psychopathology and Symptoms of Atrial Fibrillation
Introduction: Current guidelines recommend that the choice of AF management strategy be guided by the symptomatic status of the patient when in AF. However, little is known regarding what drives AF symptoms. Several limited studies suggest that psychological distress may be linked with AF symptom severity.
Methods: A total of 300 patients with documented AF completed a questionnaire assessing general health and well-being, including a comprehensive psychological assessment as well as disease-specific measures of AF symptom severity. AF burden was determined by 1-week continuous looping monitor in a subset of patients. Analysis of covariance was used to determine the association between individual measures of depression, anxiety, and somatization disorder symptom severity with measures of general health status and AF-specific symptom severity, adjusting for important confounders.
Results: Patients with worsened severity of depression, anxiety, or somatization disorder symptoms had an associated increase in the severity of symptoms attributed to AF regardless of AF severity scale used (P < 0.0001 for each measure of psychological distress). This association persisted after adjusting for important confounders. Increasing severity of depression and anxiety symptoms were also associated with increased visits to medical care for AF management.
Conclusions: Our study demonstrates the consequence of psychological distress on AF-specific symptom severity and healthcare resource utilization. Psychological well-being may strongly influence symptom severity and healthcare utilization. An assessment of psychological distress may be an important adjunct to standard AF management that warrants further study, particularly if symptom relief is the primary goal.
Atrial fibrillation (AF), the most common arrhythmia in adults, is growing to near epidemic proportions as the population ages. Prospective randomized trials comparing a strategy of heart rate control with anticoagulation as necessary with a heart rhythm control strategy utilizing antiarrhythmic medications have failed to detect a significant difference in mortality or stroke with either strategy. However, several studies of a rhythm control strategy have suggested that improved AF symptoms and overall quality of life can be achieved in patients with substantial symptoms associated with AF. It is also possible that rhythm control using catheter ablation, with its higher success rate than antiarrhythmic medications, might have more of an impact on quality of life.
Current guidelines thus recommend the choice of AF management strategy be guided by the symptomatic status of the patient when in AF. However, despite an emphasis on relief of AF symptoms as justification for a rhythm control strategy, there is a clear deficiency in our understanding of what it is about AF itself, or other pathologies coexistent with AF, that drive patient-reported symptoms of AF.
Several limited studies suggest that psychological distress may be linked with patient-reported AF symptom severity (AFSS). Patients with AF have a high prevalence of anxiety and depression. Symptoms of depression and anxiety are a strong predictor of worsened quality of life in patients with AF. Depression and anxiety may be more important than number of AF episodes in predicting AFSS. In fact, anxiety and depression may be important predictors of worsened outcomes in patients with AF.
There are, however, limited data investigating the association between anxiety and depression and severity of symptoms that patients attribute to AF. No earlier studies have considered a disease-specific measure of symptom severity rather than general quality of life. No earlier studies have comprehensively considered anxiety, depression, and somatization as potential forms of psychological distress. In addition, there are novel tools for the measurement of symptom severity that both patients and physicians attribute to AF that may utilized.
To determine whether psychological distress is an important factor in patient-reported AFSS, we screened for symptoms of anxiety, depression, and somatization in a cohort of 300 outpatients with stable AF participating in the Symptom Mitigation in Atrial Fibrillation Study.
Abstract and Introduction
Abstract
Introduction: Current guidelines recommend that the choice of AF management strategy be guided by the symptomatic status of the patient when in AF. However, little is known regarding what drives AF symptoms. Several limited studies suggest that psychological distress may be linked with AF symptom severity.
Methods: A total of 300 patients with documented AF completed a questionnaire assessing general health and well-being, including a comprehensive psychological assessment as well as disease-specific measures of AF symptom severity. AF burden was determined by 1-week continuous looping monitor in a subset of patients. Analysis of covariance was used to determine the association between individual measures of depression, anxiety, and somatization disorder symptom severity with measures of general health status and AF-specific symptom severity, adjusting for important confounders.
Results: Patients with worsened severity of depression, anxiety, or somatization disorder symptoms had an associated increase in the severity of symptoms attributed to AF regardless of AF severity scale used (P < 0.0001 for each measure of psychological distress). This association persisted after adjusting for important confounders. Increasing severity of depression and anxiety symptoms were also associated with increased visits to medical care for AF management.
Conclusions: Our study demonstrates the consequence of psychological distress on AF-specific symptom severity and healthcare resource utilization. Psychological well-being may strongly influence symptom severity and healthcare utilization. An assessment of psychological distress may be an important adjunct to standard AF management that warrants further study, particularly if symptom relief is the primary goal.
Introduction
Atrial fibrillation (AF), the most common arrhythmia in adults, is growing to near epidemic proportions as the population ages. Prospective randomized trials comparing a strategy of heart rate control with anticoagulation as necessary with a heart rhythm control strategy utilizing antiarrhythmic medications have failed to detect a significant difference in mortality or stroke with either strategy. However, several studies of a rhythm control strategy have suggested that improved AF symptoms and overall quality of life can be achieved in patients with substantial symptoms associated with AF. It is also possible that rhythm control using catheter ablation, with its higher success rate than antiarrhythmic medications, might have more of an impact on quality of life.
Current guidelines thus recommend the choice of AF management strategy be guided by the symptomatic status of the patient when in AF. However, despite an emphasis on relief of AF symptoms as justification for a rhythm control strategy, there is a clear deficiency in our understanding of what it is about AF itself, or other pathologies coexistent with AF, that drive patient-reported symptoms of AF.
Several limited studies suggest that psychological distress may be linked with patient-reported AF symptom severity (AFSS). Patients with AF have a high prevalence of anxiety and depression. Symptoms of depression and anxiety are a strong predictor of worsened quality of life in patients with AF. Depression and anxiety may be more important than number of AF episodes in predicting AFSS. In fact, anxiety and depression may be important predictors of worsened outcomes in patients with AF.
There are, however, limited data investigating the association between anxiety and depression and severity of symptoms that patients attribute to AF. No earlier studies have considered a disease-specific measure of symptom severity rather than general quality of life. No earlier studies have comprehensively considered anxiety, depression, and somatization as potential forms of psychological distress. In addition, there are novel tools for the measurement of symptom severity that both patients and physicians attribute to AF that may utilized.
To determine whether psychological distress is an important factor in patient-reported AFSS, we screened for symptoms of anxiety, depression, and somatization in a cohort of 300 outpatients with stable AF participating in the Symptom Mitigation in Atrial Fibrillation Study.