PSYCHOLOGICAL FACTORS ASSOCIATED WITH SELF-REPORTED SYMPTOM BURDEN, QUALITY OF LIFE AND HEALTH CARE USAGE AMONG PAROXYSMAL ATRIAL FIBRILLATION PATIENTS

Abstract

Atrial fibrillation (AF) is associated with distressing symptoms, impaired quality of life (QoL) and hospital readmissions. Anxiety sensitivity (AnxS), a cognitive trait, predisposes individuals to interpret autonomic changes as harmful. AnxS measured with the Anxiety Sensitivity Index (AnxSI), has been associated with AF symptoms independently of objective disease variables. The more recently developed AnxSI-R provides dimensional scores including fear of cardiovascular/somatic reactions. We report from an ongoing study, to: 1) describe clinician- and self-reported AF symptom burden, self-reported health care usage, QoL, anxiety and depression among AF patients at differing care stages; 2) determine whether AnxSI-R scores were associated with AF symptom burden, health-care usage and QoL, independently of age, sex and left atrial diameter from echocardiogram (echo-LAD). To date, 59 eligible consenting subjects (24 females; mean age=57.6 years) with paroxysmal AF, LVEF>55%, no documented stroke/TIA, recruited from an outpatient arrhythmia clinic between Sept/13-April/17, have been categorized as: 1) non-candidates for catheter ablation, n=20; 2) ablation candidates, n=19, mean anticipated time to ablation= 5.6 weeks; 3) ablation, n=20, mean post-ablation interval =20.1 weeks. Measurement included: Canadian Cardiovascular Society Severity of Atrial Fibrillation Scale (SAF; 0-5 mild-severe; clinician-completed); Atrial Fibrillation Severity Scale (AFSS: burden 0-5 low-high; health-care usage 0-6 low-high; well-being/QoL 1-10 low-high), Hospital Anxiety and Depression Scale (HADS; anxiety, depression each 0-21 mild-severe), and AnxSI-R (0-168 mild-severe), patient-completed. Echo-LAD was available for 23 subjects. Parametric and non-parametric statistics were used to analyze continuous and categorical variables, respectively. Stepwise multiple regression with covariates age, sex echo-LAD and the AnxSI-R cardiovascular/somatic score was used to predict subjective (AFSS) symptom burden, well-being and health-care usage. The ablation group had significantly lower CCS-SAF arrhythmia symptom ratings (table) compared to each of the other groups (p < .001). Mean subjective symptom burden (figure) was higher in the ablation candidates vs. each of the other groups (p < .001). Health-care usage was significantly lower among non-candidates compared to ablation (p < .049). None of mean well-being/QoL, anxiety or depression varied significantly between groups. From regression (n=23): AnxS cardiovascular/somatic score (R=.55, p=.006) predicted symptom burden; sex (R=.45, p=.031) predicted well-being; AnxS cardiovascular/somatic score (R=.44, p=.038) predicted health-care usage. AF symptom burden, highest in ablation candidates, may be affected by AnxS independently of objective disease severity. As symptom burden influences treatment decisions, psychological factors may warrant consideration. The AnxSI-R has potential for identifying high-AnxS patients.View Large Image Figure ViewerDownload Hi-res image Download (PPT)