Impact of symptom control on health-related quality of life in atrial fibrillation patients: the psychologist's viewpoint

Abstract

This editorial refers to ‘Impact of the control of symptomatic paroxysmal atrial fibrillation on health-related quality of life’ by L. Guedon-Moreau et al. , on page 634. Atrial fibrillation (AF) can be a highly symptomatic arrhythmia, with patients reporting palpitations, dizziness, breathlessness, exercise intolerance, and fatigue.1 Thus, it is unsurprising that AF patients report a reduction in their quality of life (QoL) when compared with the age- and sex-matched general population in sinus rhythm.2–4 Given that AF is a chronic condition that places patients at increased risk of mortality and morbidity, and often requires life-long treatment, including long-term oral anticoagulation, QoL is, therefore, an important treatment outcome when measuring patients' physical, emotional, and social functioning, as well as their perceived health. As reviewed by Thrall et al .,5 many previous studies have shown that AF patients have poorer QoL when compared with age-comparable healthy controls and the general population, particularly general health, vitality, physical, social, and emotional role functions; however, QoL does improve with symptom alleviation. Thus, should we aggressively pursue the goal of symptom alleviation when managing AF patients? Guendon-Moreau et al .6 examined the impact of flecainide acetate-controlled release (flecainide CR), an antiarrhythmic drug, on the QoL of controlled [defined as ≤1 symptomatic paroxysmal AF (PAF) episode within 6 months] and uncontrolled (defined as ≥2 symptomatic PAF episodes within 6 months) PAF patients. Patients were treated with flecainide CR over a 48-week period and followed up 12, 24, and 48 weeks later. QoL was assessed at each of these time-points using the short-form health survey-36 items (SF-36).7 At baseline, patients with controlled PAF had significantly better mental health ( P = 0.029), vitality ( P = 0.001), and general health ( P = 0.01) component scores than the uncontrolled group. When compared with a healthy … *Corresponding author. Tel: +44 121 507 5080; fax: +44 121 507 5907, Email: deirdre.lane{at}swbh.nhs.uk