Which Atrial Fibrillation Patients Are Most Likely to Misreport Symptoms?

JANUARY 30, 2015
Jeannette Y. Wick, RPh, MBA, FASCP
A primary goal of managing atrial fibrillation (AF) is relief of symptoms that include dizziness, fatigue, palpitations, shortness of breath, and chest pain. Yet, AF is symptomless in up to one-third of patients.

Conversely, some patients are extremely sensitive and report symptoms that are out of proportion to what similarly burdened patients normally report. Both extremes complicate symptom-targeted treatment.

A study published online ahead of print on January 13, 2015, in Heart Rhythm looked at patients’ perceptions of AF symptoms and identified factors that seem to be related to extremely inaccurate perceptions of AF episode frequency and duration.

Cardiac practitioners from the University of North Carolina at Chapel Hill administered the AF Symptom Severity Questionnaire to 458 outpatients with documented AF and examined demographic and health status data. They also had patients wear continuous heart monitors for 1 week, and patients estimated the length and frequency of their AF episodes. After data collection, the researchers compared patient perceptions with expected AF burden based on heart monitor results.

Outliers representing 15% of the overall study population occurred in 2 distinct patterns:

·      Patients with AF burden <10% verified by heart monitor who indicated near-continuous AF (overestimators)
·      Patients with burden >90% verified by heart monitor who estimated little to no AF (underestimators).

Patients with persistent AF, women, older individuals, and those diagnosed with anxiety or depression were most likely to have inaccurate perceptions and either underestimate or overestimate their AF symptoms. Those who underestimated their AF—a group twice as large as overestimators—were more likely to have persistent AF. Women and older patients also reported fewer AF symptoms.  
Patients with anxiety or depression were considerably more likely to overestimate symptoms, with anxiety having a stronger relationship to overestimation than depression.

The majority of patients (85%) perceived their prevailing AF rhythm relatively accurately.

The researchers suggested that clinicians need to consider these modulating factors when evaluating treatment strategies and use heart monitors to determine actual AF burden more often. In addition, they advocated better education of patients to help them understand when they misreport symptoms.