Anxiety, Mood May Disrupt How Patients Perceive AF Symptoms

CHAPEL HILL, NC — A substantial minority of patients with atrial fibrillation (AF), perhaps 15%, may be "extremely inaccurate" in estimating the prevalence and duration of their arrhythmic episodes, with those having anxiety or mood disorders perhaps more likely to overestimate, suggests a prospective study^[1].

As reported by Roja S Garimella (Brown University, Providence, RI) January 13, 2015 in Heart Rhythm, 458 outpatients with documented AF filled out an AF symptom-severity questionnaire with self-estimates of their predominant rhythm, which were compared with the results of 7 days of continuous ECG monitoring.

Whereas a "remarkable" 85% of patients were "relatively accurate in their perception of their prevailing AF rhythm," the group writes, the remainder showed either a <10% AF burden yet self-reported nearly continuous AF (that is, were "overestimators") or an AF burden of >90% while perceiving no or nearly no AF ("underestimators").

"Psychological comorbidities (anxiety and depression) strongly predicted overestimating, with anxiety being the stronger correlate of the two," according to Garimella et al. "Underestimating was associated with age and gender, with elderly and female participants more prone to understating the length and frequency of their AF episodes."

Given that anxiety and depression are more prevalent in patients with AF than in the general population, they propose, "clinicians should be wary of relying solely on patient reports of symptoms and subjective measures of AF burden when therapies may be targeted on relief of AF in hopes of resolving symptoms."

There were 23 overestimators (about 5% of the cohort) and 45 underestimators (almost 10% of the cohort). The latter group was significantly older and less prone to anxiety or depression.

Multivariate Odds of Overestimating, Underestimating AF as Prevailing Rhythm

Treatment of AF isn't generally needed in the absence of symptoms, "even if the prevailing rhythm is continuous AF," write the authors. On the other hand, they continue, treatment is often appropriate even if the patient is mostly in sinus rhythm.

"Patient misperception of AF-attributable symptoms could lead to ineffective treatment that is targeting the wrong problem or based on misunderstandings or miscommunication of symptoms between patients and providers," according to Garimella et al. Continuous ECG monitoring "could be useful to identify discrepancies between patient reports and prevailing rhythms."

Garimella and the other authors report they have no relevant financial relationships.

Heartwire from Medscape © 2015  Medscape, LLC

Cite this: Anxiety, Mood May Disrupt How Patients Perceive AF Symptoms - Medscape - Jan 26, 2015.