Effect of anxiety and depression on the recurrence of persistent atrial fibrillation after circumferential pulmonary vein ablation

BACKGROUND

The effects of anxiety and depression on the recurrence of persistent atrial fibrillation (AF) after circumferential pulmonary vein ablation (CPVA) are not clear. Whether CPVA can alleviate the anxiety and depression symptoms of persistent AF patients is unknown.

METHODS

One hundred and sixty-four patients with persistent AF, of which 43 treated with CPVA (CPVA group) and 103 treated with anti-arrhythmics drugs (medicine group), were enrolled. The Zung Self-Rating Anxiety Scale (SAS), and Zung Self-Rating Depression Scale (SDS) were assessed before and 12 months after treatment in all patients.

RESULTS

The scores of SAS (40.33 ± 7.90 vs. 49.76 ± 9.52, P < 0.01) and SDS (42.33 ± 8.73 vs. 48.17 ± 8.77, P < 0.01) decreased 12 months after CPVA. Over 12 months follow-up, AF relapsed in 17 patients in CPVA group. Compared with the data in the recurrent group (17 patients), the scores of SAS and SDS were significantly lower in the non-recurrent group (26 patients) at baseline. The results of multivariate Logistic regression analysis showed normal scores of SAS and SDS were the independent risk factors of AF recurrence after CPVA.

CONCLUSIONS

Anxiety and depression increase the recurrence risk of persistent AF after CPVA. CPVA can ameliorate the anxiety and depression symptoms in patients with persistent AF.

Factors associated with 'caregiver burden' for atrial fibrillation patients

BACKGROUND

The burden on caregivers providing support to atrial fibrillation (AF) patients has not been evaluated.

OBJECTIVE

To examine the interrelationship between unpaid caregiver, patient and thromboprophylaxis characteristics and caregiver burden in AF.

METHODS

We conducted a cross-sectional survey study of AF patient-caregiver dyads recruited from cardiology clinics at an urban teaching hospital. Eligible patients had a diagnosis of AF, received thromboprophylaxis to prevent stroke, lived in the community and had an adult, unpaid, English-speaking caregiver. Hierarchical multivariate regression was used to evaluate the association between caregiver, patient and thromboprophylaxis characteristics and caregiver burden as measured by the 'Caregiver Reaction Assessment' (CRA).

RESULTS

Eighty patient-caregiver dyads were surveyed. The mean ± standard deviation scores for each CRA domain were 'Disrupted schedule' (2.4 ± 1.0), 'Financial problems' (2.1 ± 0.8), 'Lack of family support' (1.9 ± 0.7), 'Health problems' (1.9 ± 0.7) and 'Self-esteem' (0.9 ± 0.5). Significantly greater caregiver burden due to 'Disrupted schedule' was seen in those spending > 4 h/week providing care and when caring for frail, sick or disabled patients, with higher CHADS2 scores and requiring help with their medications. 'Financial problems' burden scores were significantly associated with caring for frail patients and those requiring more frequent office follow-up. 'Lack of family support' scores were inversely associated with having somebody else to help provide care and increased as patients CHADS2 score increased. Lower 'Health problem' burden scores were associated with female gender and higher scores with the need to spend > 4 h/week providing care.

CONCLUSION

The greatest burden to caregivers of AF patients occurs due to schedule disruption.

Gender, lifestyles, illness perception and stress in stable atrial fibrillation

AIMS

The study is aimed at investigating if perceived stress in Stable Atrial Fibrillation (AF) has any gender-associated feature and relationships with lifestyle indicators and education level, and which relationship self efficacy, anxiety and depression and illness perception have, if any.

PATIENTS AND METHODS

88 consecutive patients referred for stable AF are studied by Psychological Stress Measure (PSM) test, Illness Perception Questionnaire (IPQ-R), Generalized Self-Efficacy scale (GSE) and Hospital Anxiety and Depression Scale (HADS). Mediterranean diet, physical activity increase and smoking withdrawal counseling were provided.

RESULTS

AF patients have higher PSM associated with gender (women), older age, anxiety and depression. Higher GSE, greater Adherence to Mediterranean Diet profile and coffee habits (greater coffee users) are associated with a reduced hazard of perceived stress. By multiple linear regression, PSM is explained by Anxiety and IPQr (statistically significant are emotional representation and illness coherence subscales), which account for 92.2% of the variance (p<0.0001).

CONCLUSION

Our results outline that psychological stress is greater in women in comparison with men. Illness perceptions are important in the context of perceived stress in AF. This effect appears to be modulated by greater self-efficacy and by Adherence to Mediterranean Diet profile, that when higher, are associated with a reduced hazard of perceived stress. We suggest that therapeutic interventions on illness perceptions can be warranted in order to achieve a lower psychological distress in AF patients.

Predictors for 5-year survival in a prospective cohort of elderly stroke patients

OBJECTIVES

To examine predictors for 5-year survival in elderly stroke patients.

MATERIALS AND METHODS

Prospective cohort study of 186 consecutive acute stroke patients aged ≥65 years admitted to Bankstown-Lidcombe Hospital, Australia 03/2002 to 03/2003. All subjects were followed up in 2007/8, at 5 years post-stroke, for outcome measures. Logistic regression analysis was performed to predict 5-year survival using covariables, including functional status, age, stroke type and severity and vascular risk factors. Patients lost to follow-up (n = 20) were excluded from the analyses.

RESULTS

One hundred patients (60%) were dead at study end. Predictors for survival in final logistic regression model were as follows: Glasgow Coma Scale (GCS) on admission (OR 1.49, 95%CI 1.1-2.0, P = 0.01), preadmission functional independence measure (FIM) score (OR 1.04, 95%CI 1.0-1.1, P = 0.01), age (OR 0.93, 95%CI 0.87-0.98, P = 0.01) and atrial fibrillation (OR 0.43, 95% CI 0.19-0.95, P = 0.04). For 5-year survivors, mean Modified Rankin Scale was 3.1 ± 1.5, total FIM score 85 ± 32, mini-mental state examination (MMSE) 22 ± 8 and Hospital Anxiety and Depression (HAD) scores 5.4 ± 3.4 and 5.2 ± 3.9, respectively. FIM cognition score was significantly lower at 5 years when compared to baseline (24 ± 8 vs 29 ± 8, P < 0.05) (all scores expressed as mean ± SD). In contrast, MMSE, HAD and total FIM scores were not significantly different at 5 years when compared to baseline.

CONCLUSIONS

The study identified lower GCS on admission, lower preadmission FIM score, age and atrial fibrillation as negative predictors for 5-year survival following stroke.

Mental health and sleep in permanent atrial fibrillation patients from the general population

BACKGROUND

Anxiety and depression has been found in atrial fibrillation (AF) patients referred to secondary care. Little is known about the level of such distress in AF patients from the general population.

HYPOTHESIS

Permanent AF patients from the general population might have more anxiety, depression, and sleep impairment than subjects in sinus rhythm.

METHODS

Patients with permanent AF and controls in sinus rhythm were recruited from a 75-year-old cohort from 2 Norwegian municipalities. The main outcome variables were anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS) and sleep quality measured by Pittsburgh Sleep Quality Index (PSQI) score. Short Form 36 (SF-36) was also completed.

RESULTS

Twenty-seven patients with permanent AF and 71 subjects in sinus rhythm participated. No significant score differences were found between AF patients and controls for HADS anxiety (median, inter quartile range, 3 [1, 5] vs 4 [1, 6]; HADS depression, 3 [1,6] vs 2 [1,4]; and PSQI 6 [3, 11] vs 5 [4, 8]). AF patients had significantly poorer scores for SF-36 physical functioning, physical role, general health, vitality, and social functioning compared to subjects in sinus rhythm.

CONCLUSIONS

Elderly permanent AF patients from the general population had similar levels of anxiety, depression, and sleep quality, despite poorer physical health-related quality of life compared to controls in sinus rhythm. Copyright © 2011 Wiley Periodicals, Inc. This work was supported by unrestricted grants from the governmental Health Region South-East, Norway, and from the Stein Erik Hagen Foundation for Clinical Heart Research, Norway. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Pharmacological treatment of persistent atrial fibrillation in the older adult: evidence-based practice

PURPOSE

To answer the clinical question: In adults over 65 years of age with persistent atrial fibrillation (AF), do pharmacological rhythm-control agents offer a lower risk of stroke when compared to pharmacological rate-control agents? To address whether or not rhythm control improves quality of life compared to rate control was a secondary outcome question.

DATA SOURCES

Comprehensive review of pharmacological treatment of AF on stroke and quality of life outcomes; a meta-analysis of five randomized controlled trials.

CONCLUSIONS

Research suggests that all AF patients should continue anticoagulant therapy long term, even if they convert to sinus rhythm. Adequate rate control or rhythm control does not appear to reduce the need for lifelong antithrombotic therapy.

IMPLICATIONS FOR PRACTICE

While an individualized treatment approach to AF is essential, a strong focus in the care of the older adult with AF should be on maintaining therapeutic International Normalized Ratio (INR) levels. Improved quality of life is more dependent on reducing thromboembolic events and subsequent sequelae of stroke.

Development and validation of the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) Questionnaire in patients with atrial fibrillation

BACKGROUND

Atrial fibrillation (AF) has a deleterious impact on health-related quality-of-life (HRQoL), but measuring this outcome is difficult. A comprehensive, validated, disease-specific questionnaire to measure the spectrum of QoL domains affected by AF and its treatment is not available. We developed and validated a 20-item questionnaire, Atrial Fibrillation Effect on QualiTy-of-life (AFEQT), in a 6-center, prospective, observational study.

METHODS AND RESULTS

Factor analyses established 4 conceptual domains (Symptoms, Daily Activities, Treatment Concern, and Treatment Satisfaction) from which individual domain and global scores were calculated. Participants from 6 centers completed the AFEQT at baseline, at month 1, and at month 3. Psychometric analyses included internal consistency and known-group validity. Test-retest reliability was assessed by comparing 1-month changes in scores among those with no change in therapy. Effect size was used to assess responsiveness after intervention. Among 219 patients age 62±11.9 years, 94% completed the AFEQT at baseline and 3 months; 66% had paroxysmal, 24% persistent, 5% longstanding persistent, and 5% permanent AF. Internal consistency was >0.88 for all scales. Lower AFEQT scores were observed with increased AF severity, categorized as asymptomatic, mild, moderate and severe, respectively: 71.2±20.6, 71.3±19.2, 57.9±19.0, and 42.0±21.2. Intraclass correlations for Overall, Symptoms, Daily Activities, Treatment Concern, and Satisfaction scores were 0.8, 0.5, 0.8, 0.7, and 0.7, respectively. Changes in 3-month scores were larger after ablation than with pharmacological adjustments, and both were greater than those observed in stable patients.

CONCLUSIONS

This initial validation of AFEQT supports its use as an outcome in studies and a means to clinically follow patients with AF.

Impact of hospitalization on health-related quality of life in atrial fibrillation patients in Canada and the United States: results from an observational registry

BACKGROUND

Hospitalization is recognized as an important end point in atrial fibrillation (AF). The association between hospitalization and reduced health-related quality of life (HRQOL) has not been previously studied.

METHODS

The FRACTAL study was a prospective observational registry of patients enrolled in the United States and Canada with new-onset AF diagnosed by electrocardiogram. HRQOL was assessed with the SF-12 and the AF Symptom Checklist at baseline, 3, 6, 12, 24 and 30 months. Mixed linear regression models were fitted to estimate the impact of hospitalization on HRQOL summary scores, adjusting for demographic and baseline comorbid conditions known to influence HRQOL in this population.

RESULTS

Of 933 subjects who completed questionnaires and were not hospitalized during the baseline study visit, 303 (32%) were hospitalized a total of 490 times during a mean of 2.0 years of follow-up. Most admissions (64%) were for cardiovascular causes. The adjusted effect of any hospital admission (vs none) on symptom frequency and severity scores over time was +1.3 and +1.1 points, respectively (P < .01 for both). The adjusted effect of any admission on the SF-12 physical score was -2.7 points (P < .0001) and on health state utility, -0.03 (P < .0001). In contrast, hospitalization had little effect on longitudinal Short Form 12 mental scores (-0.7 points, P = .15).

CONCLUSIONS

Within 2 years after AF diagnosis, hospitalizations were associated with increased AF symptomatology and decrements in generic physical HRQOL and utilities. Based on these results, interventions that reduce admissions in AF patients may also improve or preserve HRQOL.

Quality of life and depression in patients with different patterns of atrial fibrillation

BACKGROUND

atrial fibrillation (AF) is difficult to cure and significantly affects quality of life was well as emotional status of patients.

AIM

to evaluate quality of life and depression level in patients with various patterns of AF.

METHODS

we studied 150 consecutive patients with AF aged 35-83 years, including 61 patients with paroxysmal AF, 46 patients with persistent AF, and 43 patients with permanent AF. The control group included 70 healthy persons (mean age: 55.5 ± 14.5 years). Quality of life was estimated using the Nottingham Health Profile questionnaire. Risk of depression occurrence was estimated using the Beck Depression Inventory scale. Physical abilities, energy level, pain, emotional reactions, sleep, social isolation, problems with work, family life and sexual life were analysed.

RESULTS

the mean age of patients with paroxysmal AF was higher in comparison to patients with permanent AF (68.4 ± 9.4 vs 62.0 ± 9.2 years, p < 0.05). In patients with all AF forms, the prevalence of symptoms indicating depression was significantly higher in comparison with control group (paroxysmal AF: 10.8 ± 5.8%, persistent AF: 10.0 ± 6.4%, permanent AF: 10.1 ± 7.2% vs 5.7 ± 5.8% in controls, p < 0.01). The level of depression was higher in women regardless of AF form (p < 0.005). Patients with paroxysmal and permanent AF had lower scores of emotional reactions (p < 0.05) and social isolation (p < 0.05) in comparison with the control group. All patients with AF had lower scores of energy level in comparison with the control group (paroxysmal AF: 1.2 ± 0.2, persistent AF: 1.1 ± 0.2, permanent AF: 1.2 ± 0.2 vs 0.5 ± 0.1 in controls, p < 0.005). Patients with paroxysmal, persistent and permanent AF had greater degree of activity limitations than the control group (1.8 ± 0.2, 1.7 ± 0.3, 2.1 ± 0.3, respectively, vs 1.0 ± 0.2, p < 0.005). Limitations of work were detected in 28.6-35.9% of patients with various forms of AF, sex life disturbances in 23.8-33.9% of patients, and family life problems in 10.3-21.4% of patients. The lowest results of these scores were noted in patients with paroxysmal AF.

CONCLUSIONS

atrial fibrillation, independently of its form, has substantial impact on the risk of depression occurrence. Patients with paroxysmal and permanent AF had lower self-evaluation of their energy level. In all studied groups of AF patients, the arrhythmia significantly limited quality of life, especially sexual life as well as professional and home activity.

[Analysis on long-term compliance of anticoagulation treatment and demands of disease management in patients with atrial fibrillation]

OBJECTIVE

To analyze the long-term compliance of oral anticoagulant therapy and the demands of disease management in patient with atrial fibrillation (AF).

METHODS

Inpatients with AF taking warfarin were collected from Department of Internal Medicine from January 1 to December 31, 2008. Inpatients from departments of surgery, ophthalmology, otorhinolaryngology, dermatology and pediatrics and those on a previous warfarin therapy were excluded. The data of patient profiles, medical history and anticoagulant treatment were collected from electronic medical record. And the status of anticoagulant treatment one year later and demands of disease management were inquired by telephone.

RESULTS

A total of 268 AF patients received a telephone survey. Among them, 145 patients (54.1%) continued taking warfarin. Gender, age, type of AF, duration of AF and history of ischemic stroke was not significantly associated with the compliance of anticoagulant treatment. The odds ratio was 1.74 (95%CI: 0.67-4.47), 0.87 (95%CI: 0.30-2.53), 1.59 (95%CI: 0.35-1.09), 1.09 (95%CI: 0.61-1.93) and 0.44 (95%CI: 0.12-1.60) respectively. Among patients on warfarin, INR was monitored monthly in 88 patients (60.7%) and 70 patients (48.3%) had an INR value of 2.0-3.0. Among 123 withdrawal patients, 88 patients (71.5%) terminated treatment within 6 month. The common reasons included patient ignorance about long-term anticoagulant treatment (35.0%) and switching to aspirin because of a poor effect (24.4%). About 80% of patients wished to obtain instructions about INR monitoring and adjustment of drug dosage. Among them, 196/268 patients (73.1%) wished for a regular follow-up. And 176/196 patients (89.8%) opted for a telephone follow-up and 150/176 patients (85.2%) wanted to receive monthly instructions.

CONCLUSION

The compliance of anticoagulation treatment and the target-meeting proportion of INR value are relative low. And the common reasons of withdrawal are patient ignorance about long-term anticoagulant treatment and switching to aspirin because of a poor effect. Disease management will meet most of AF patients' demands.

The impact of depression in heart disease

Depression and heart disease affect millions of people worldwide. Studies have shown that depression is a significant risk factor for new heart disease and that it increases morbidity and mortality in established heart disease. Many hypothesized and studied mechanisms have linked depression and heart disease, including serotonergic pathway and platelet dysfunction, inflammation, autonomic nervous system and hypothalamic-pituitary-adrenal axis imbalance, and psychosocial factors. Although the treatment of depression in cardiac patients has been shown to be safe and modestly efficacious, it has yet to translate into reduced cardiovascular morbidity and mortality. Understanding the impact and mechanisms behind the association of depression and heart disease may allow for the development of treatments aimed at altering the devastating consequences caused by these comorbid illnesses.

Impact of the control of symptomatic paroxysmal atrial fibrillation on health-related quality of life

AIMS

Patients with atrial fibrillation (AF) consider the related symptoms disruptive to their quality of life (QoL). This study aimed to evaluate the impact of the control of symptomatic paroxysmal AF (PAF) on QoL.

METHODS AND RESULTS

Patients with symptomatic PAF were treated for 48 weeks with open-label flecainide acetate controlled release (Flec CR). Quality of life was assessed by SF-36 and Atrial Fibrillation Severity Scale scores at baseline, Week 12 (W12), W24, and W48. Of the 229 treated patients, 217 were analysed for QoL (123 with controlled and 94 with uncontrolled symptomatic PAF at inclusion). The controlled group had a similar or better QoL (SF-36) at baseline compared with a reference population (significantly better for: physical functioning, bodily pain, and physical component). The uncontrolled group had an inferior QoL (significantly worse for: role physical, general health, vitality, role emotional, social functioning, mental health, and mental component). When treated with Flec CR, the controlled group baseline QoL scores were maintained and the uncontrolled group scores were improved to a level comparable to the controlled group scores. Safety findings reflect the known clinical safety profile of flecainide acetate.

CONCLUSION

In this study, patients with uncontrolled symptomatic PAF at baseline had an inferior QoL to those with controlled symptomatic PAF. Following treatment with controlled-release flecainide acetate, their QoL improved to a level comparable to controlled patients.

Quality of Life in elderly inpatients with atrial fibrillation as compared with controlled subjects

OBJECTIVES

Since few studies have investigated Health related Quality of Life (HRQoL) in older patients with atrial fibrillation, the aim of this cross-sectional study was to compare HRQoL in AF elderly inpatients of 65 and more with that of age-matched controlled subjects.

DESIGN

HRQoL was assessed with two generic HRQoL instruments: the MOS-SF 36, a largely recognized instrument, and the Duke Health Profile.

SETTING AND PATIENTS

Nancy University Hospital patients presenting with atrial fibrillation and three controls per patient free of cardiac arrhythmias, matched by age, sex and hospital department to atrial fibrillation patients.

RESULTS

Forty one atrial fibrillation patients and 123 controls were included. Both groups were comparable for associated disorders, other than coronary artery disease and chronic respiratory failure. After adjustment, scores among atrial fibrillation patients were lower than among controls in 8 of 10 Duke and 6 of 8 SF-36 subscales. In terms of Quality of Life, meaningful differences (>or= 5 points) were recorded in the Duke: Mental, Depression, Anxiety, General Score; and in the SF-36: Physical functioning, Role emotional, Social functioning and Vitality. Nevertheless statistically significant differences were only observed for the Duke Mental (p=0.01), Depression (p=0.003) and Anxiety (p=0.03) scores.

CONCLUSIONS

In our study HRQoL measured in elderly inpatients with atrial fibrillation as compared with matched controlled was mainly altered in the "psychological" domains of the Duke Health Profile. From the patient's point of view, atrial fibrillation appears to have more mental than physical consequences. This study pointed out the utility to assess HRQoL in the management and treatment of elderly hospitalised atrial fibrillation patients.

[Measurement of anxiety with C.D. Spielberger's test in patients with cardiac arrhythmias]

INTRODUCTION

Atrial fibrillation is a common supraventrical arrhythmia. The onset of fibrillation is marked by fear of loss of health or life. Symptoms of depression occur concurrently. This study was undertaken to measure anxiety in patients with atrial fibrillation grouped according to gender, age, and education.

MATERIAL AND METHODS

The test anxiety inventory of C.D. Spielberger was administered to 52 patients aged 41 to 80 years, treated for atrial fibrillation at the Internal Ward of the District Hospital in Białogard.

RESULTS

Anxiety as a state was observed more frequently in males and in patients with vocational and secondary education. Anxiety was not a trait of atrial fibrillation. Psychotherapeutic interventions used in cardiac rehabilitation are not recommended in atrial fibrillation. However, relaxation techniques could be of benefit in reducing the intensity of anxiety as a state.

[Clinical condition of patients with persistent form of atrial fibrillation before and after cardioversion]

The aim of the study was to examine effect of cardioversion (CV) on the subjective and objective status of patients with persistent atrial fibrillation (AF) receiving different therapy. The study included 4 groups of patients (n = 85). Group 1 (n = 30) were given standard treatment. In group 2 (n = 25), standard therapy was supplemented by i.v. injections of emoxipin (200 mg/day). Treatment of group 3 (n = 10) included mildronat (50 mg/day, i.v.), patients of group 4 (n = 20) were given riboxin (200 mg/day, i.v.). It was shown that the recovery of sinus rhythm improved the quality of life and parameters of cardiovascular function in all the treated patients.

Depression, anxiety, and quality of life in patients with atrial fibrillation

OBJECTIVE

To examine the prevalence and persistence of depression and anxiety in patients with atrial fibrillation (AF), and their effect on future quality of life (QoL) status.

METHODS

The Beck Depression Inventory and State-Trait Anxiety Inventory were completed by 101 patients with AF (62 men; mean age +/- SD, 66.3 +/- 11.0 years), who were compared to 97 patients with hypertension (as "disease control" subjects) in sinus rhythm (64 men; mean age, 68.0 +/- 7.2 years) at baseline and at 6 months. QoL was ascertained at both time points using Dartmouth Care Cooperative Information Project charts.

RESULTS

At baseline among AF patients, symptoms of depression, state anxiety, and trait anxiety prevailed in 38%, 28%, and 38%, respectively; analogous data for hypertensive patients were 30%, 23%, and 22%. AF patients displayed higher levels of trait anxiety (p < 0.05), with no significant differences in baseline depression, state anxiety, and QoL between patients with AF and disease control subjects. Symptoms of depression and anxiety (state and trait) persisted at 6 months in 36.8% and 33.3%, respectively. Symptoms of depression (p < 0.001) and anxiety (p < 0.001) at baseline, female gender (p = 0.01), ethnicity (p = 0.01), and employment status (p = 0.03) were significantly correlated with QoL at 6 months in the patients with AF. Multiple regression analysis revealed that baseline depression score provided the best independent prediction of 6-month QoL (R(2) = 0.20), although gender and employment status also entered the model.

CONCLUSION

Approximately one third of AF patients have elevated levels of depression and anxiety, which persist at 6 months. Symptoms of depression were the strongest independent predictor of future QoL in these patients.

Development of a questionnaire to measure health-related quality of life (HRQoL) in patients with atrial fibrillation (AF-QoL)

Background

The Health-Related Quality of Life (HRQoL) assessment in atrial fibrillation (AF) patients has traditionally been carried out in a poorly standardised fashion, or via the use of non disease-specific HRQoL questionnaires. The development of a HRQoL questionnaire with a good measuring performance will allow for a standardised assessment of the impact of this disease on the patient's daily living.

Methods

A bibliography review was conducted to identify the most relevant domains of daily living in AF patients. Subsequently, a focus group was created with the aid of cardiologists, and 17 patients were interviewed to identify the most-affected HRQoL domains. A qualitative analysis of the interview answers was performed, which was used to develop a pilot questionnaire administered to a 112-patient sample. Based on patient responses, an analysis was carried out following the statistical procedures defined by the Classical Test Theory (CTT) and the Item Response Theory (IRT). Reliablility was assessed via Cronbach's coefficient alpha and item-total score correlations. A factorial analysis was performed to determine the number of domains. For each domain, a Rasch analysis was carried out, in order to reduce and stand hierarchically the questionnaire items.

Results

By way of the bibliography review and the expert focus group, 10 domains were identified. The patient interviews allowed for the identification of 286 items that later were downsized to 40 items. The resultant preliminary questionnaire was administered to a 112-patient sample (pilot study). The Rasch analysis led to the definition of two domains, comprising 7 and 11 items respectively, which corresponded to the psychological and physical domains (18 items total), thereby giving rise to the initial AF-QoL-18 questionnaire. Cronbach's coefficient alpha was acceptable (0.91).

Conclusion

An initial HRQoL questionnaire, AFQoL-18, has been developed to assess HRQoL in AF patients.