Atrial fibrillation (AF) is the most common arrhythmia in adults and is rapidly reaching epidemic proportions in the United States. Recent studies have suggested that treatment of AF correlates with enhanced overall quality of life. According to current guidelines, the choice of management strategy for AF should be guided by the symptomatic status of patients due to AF. Despite the emphasis being placed on relief of AF symptoms, several smaller investigations have suggested that psychological distress may be linked with patient-reported AF symptom severity.
Some analyses have shown that patients with AF have a high prevalence of anxiety and depression. It’s possible that depression and anxiety may be more important than the number or duration of AF episodes in predicting AF symptom severity. These conditions may also be important predictors of worsened outcomes in patients with AF. Few studies, however, have investigated the association between anxiety and depression and severity of symptoms that patients attribute to AF.
Intriguing New Data on Patients with Atrial Fibrillation
To determine whether psychological distress is an important factor in patient-reported AF symptom severity, my colleagues and I performed a study—published in the Journal of Cardiovascular Electrophysiology—that examined the issue in greater detail. A cohort of 300 outpatients with stable AF was screened for symptoms of anxiety, depression, and somatization disorder. They also completed questionnaires that assessed general health and well-being, specifically measuring disease-specific AF symptom severity.
Overall, patients in the study with worsened severity of depression, anxiety, or somatization disorder symptoms had an increase in AF symptom severity regardless of the AF severity scale used (see Figure). In addition, greater severity of depression and anxiety symptoms was associated with more frequent visits to seek medical attention for AF.
Meaningful Implications on AF Management
The possibility of increased AF burden leading to both increased psychological distress and worsened AF symptom severity needs to be addressed. Anxiety, depression, and other psychological disorders can have important consequences that should be factored into how patients with AF are managed.
Although AF symptom severity appears to be greater in patients with various forms of psychological distress, the direction of this relationship remains unclear. As we seek to manage the increasing burden of AF, it’s important for clinicians to make efforts to break the cycle of worsening symptom severity, psychological distress, and healthcare utilization. It’s hoped we’ll continue striving to increase our understanding of the influence of psychological well-being on symptom relief and its effects on adherence to treatment recommendations. As more data emerge, assessment of psychological distress may become an important adjunct to standard AF care, particularly in cases for which symptom relief is the primary goal. Studies such as ours highlight the importance of addressing symptom relief in addition to AF recurrence when treating the patient with AF.
Online Exclusive Figure: Psychological Distress & AF Symptom Severity
Gehi AK, Sears S, Goli N, et al. Psychopathology and symptoms of atrial fibrillation: implications for therapy. J Cardiovasc Electrophysiol. 2012;23:473-478. Available at: http://www.medscape.com/viewarticle/763863.
Thrall G, Lip GY, Carroll D, Lane D. Depression, anxiety, and quality of life in patients with atrial fibrillation. Chest. 2007;132:1259-1264.
Ong L, Cribbie R, Harris L, et al. Psychological correlates of quality of life in atrial fibrillation. Qual Life Res. 2006;15:1323-1333.
Spertus J, Dorian P, Bubien R, et al. Development and validation of the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Questionnaire in patients with atrial fibrillation. Circ Arrhythm Electrophysiol. 2011;4:15-25.
Carney RM, Freedland KE, Veith RC. Depression, the autonomic nervous system, and coronary heart disease. Psychosom Med. 2005;67(Suppl 1):S29-S33.
Dorian P, Jung W, Newman D, et al. The impairment of health-related quality of life in patients with intermittent atrial fibrillation: Implications for the assessment of investigational therapy. J Am Coll Cardiol. 2000;36:1303-1309.