PM015 AF symptom severity and physical health status: Personality and psychology are more powerful predictors than cardiac function and cardiovascular co-morbidities

Abstract

Introduction: The influence of psychological factors on the patient experience of AF has been demonstrated to be in excess of the objective burden of AF. The balance between psychological factors and cardiac function in governing AF symptom severity has not been explored. Objectives: We aimed to analyse the severity of AF symptoms and of health-related quality of life in patients with preserved left ventricular (LV) systolic fucntionin the context of both psychological factors and of variables of left atrial (LA) and LV function. Methods: 84 participants with paroxysmal/persistent AF (n1⁄461) or longstanding/permanent AF (n1⁄423) and preserved LV systolic function completed the AF Symptom Severity Score (AFSS) and SF-36 Quality of Life questionnaires. Underlying personality type was assessed with the Perceived Stress Scale (PSS), Type D Personality Scale (TDPS) and Trait Anxiety Index (STAI-2). Anxiety and depression symptoms were assessed with the Beck Depression Index (BDI), the Hospital Anxiety and Depression Scale (HADS) and the State Anxiety Index (STAI-1). Baseline clinical factors were measured and a 2-D transthoracic echocardiogram performed for assessment of LV diastolic function and LA strain variables. Results: Younger age, paroxysmal AF, OSA and increased BMI predict more severe AF symptoms. Diabetes predicts less severe symptoms. No variable of LV diastolic function or LA strain is associated with AF symptom status. A personality tendency towards negative affectivity and social inhibition (TDPS), towards a tendency to perceive stress (PSS) and towards a chronic anxiety state (STAI-2) strongly predict more severe symptoms. The presence of anxiety and depression symptoms also strongly predicted more severe symptoms. The most powerful independent predictor of more severe AF symptoms on multivariate analysis was the presence of symptoms of depression. A poorer overall physical health status is predicted by hypertension, OSA, elevated BMI and enlarged LA area but not by any variable of LV diastolic dysfunction or LA strain. Again negative affectivity and social inhibition, higher perceived stress, higher levels of trait and state anxiety and more depression symptoms strongly predict poorer overall physical health status. Conclusion: In patients with AF and preserved LV systolic function underlying personality type and the presence of anxiety or depression symptoms rather than LV diastolic dysfunction or left atrial dysfunction predict more severe AF symptoms and poorer physical health status. Disclosure of Interest: None Declared