Differences in quality of life, anxiety and depression in patients with paroxysmal atrial fibrillation and common forms of atrioventricular reentry supraventricular tachycardias

Prevalence of demoralization and depressive symptoms in a sample of patients with supraventricular tachyarrhythmias: preliminary results

Introduction

Supraventricular tachyarrhythmias (ST) are the most common cardiac arrhythmias. Little is known about the potential impact of demoralization, which is considered as partially distinct from depression, on the course of ST. A correct assessment of both depressive symptoms and demoralization appears relevant for the treatment of these cardiac diseases, potentially influencing their course.

Methods

The sample consisted of 110 subjects affected by different ST, such as atrial fibrillation (AF), atrial flutter (AFL) and paroxysmal supraventricular tachycardia (PSVT). They all underwent a psychiatric evaluation; the Italian version of 9-item Patient Health Questionnaire (PHQ-9) and the Italian version of Demoralization Scale (DS) were administered. Descriptive statistics, pairwise comparisons, and correlational analysis have been implemented.

Results

26 individuals (23.6%) presented high levels of demoralization. Of these, 20 (76.9%) had a diagnosis of AF and six patients (23.1%) received a diagnosis of other ST. No differences in demoralization levels resulted in regard of sex, cardiac diagnoses and anticoagulant therapies. Amongst people with high levels of demoralization, 13 (50%) received no formal psychiatric diagnosis, and 12 (46.2%) showed moderate/severe depressive symptoms. Demoralization levels and PHQ-9 scores showed a significant positive correlation in the whole sample (r=0.550, p<0.001).

Discussion

The present study found that in a sample of patients suffering from ST, high levels of demoralization were more frequent than clinically relevant depressive symptoms. We propose that demoralization and depression show partially distinguished psychopathological features, potentially associated with different therapeutic trajectories.

Relationship Between Preoperative Anxiety and Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

BACKGROUND

Atrial fibrillation is a form of arrhythmia that frequently occurs after coronary artery bypass graft surgery. Psychological factors may be involved in the development of atrial fibrillation, although the specific effect of anxiety remains unclear.

PURPOSE

This study was designed to evaluate the relationship between preoperative anxiety levels and atrial fibrillation after coronary artery bypass graft surgery.

METHODS

This descriptive design study recruited a sample of 126 patients. The data were collected by the researcher using a patient information form and the State-Trait Anxiety Scale.

RESULTS

Atrial fibrillation developed in 26.5% of the sample. Those who developed atrial fibrillation had a mean trait anxiety scale score of 40.2 ± 7.8, which is statistically significant. According to the results of logistic regression, it was observed that increased trait anxiety score, increased age, presence of comorbid disease, and noncompliance with respiratory physiotherapy increased the risk of developing atrial fibrillation.

CONCLUSION/IMPLICATIONS FOR PRACTICE

Preoperative anxiety levels were shown to be a significant factor promoting the development of atrial fibrillation after coronary artery bypass graft surgery. The results support measuring anxiety levels in patients as a standard procedure before performing this surgical procedure.

Association between symptoms, affect and heart rhythm in patients with persistent or paroxysmal atrial fibrillation: an ambulatory pilot study

Symptoms in atrial fibrillation are generally assumed to correspond to heart rhythm; however, patient affect - the experience of feelings, emotion or mood - is known to frequently modulate how patients report symptoms but this has not been studied in atrial fibrillation. In this study, we investigated the relationship between affect, symptoms and heart rhythm in patients with paroxysmal or persistent atrial fibrillation. We found that presence of negative affect portended reporting of more severe symptoms to the same or greater extent than heart rhythm.

Exploring Depressive Symptoms and Anxiety Among Patients With Atrial Fibrillation and/or Flutter at the Time of Cardioversion or Ablation

BACKGROUND

Depression and anxiety in patients with atrial fibrillation (AF) and/or atrial flutter may influence the effectiveness of cardioversion and ablation. There is a lack of knowledge related to depressive symptoms and anxiety at the time of these procedures.

OBJECTIVE

We aimed to describe the prevalence and explore potential covariates of depressive symptoms and anxiety in patients with AF at the time of cardioversion or ablation. We further explored the influence of depressive symptoms and anxiety on quality of life at the time of procedure and 6-month AF recurrence.

METHODS

Depressive symptoms, anxiety, and quality of life were collected at the time of cardioversion or ablation using the Patient Health Questionnaire-9, State-Trait Anxiety Inventory, and Atrial Fibrillation Effect on Quality of Life questionnaire. Presence of AF recurrence within 6 months post procedure was evaluated.

RESULTS

Participants (N = 171) had a mean (SD) age of 61.20 (11.23) years and were primarily male (80.1%) and white, non-Hispanic (81.4%). Moderate to severe depressive symptoms (17.2%) and clinically significant state (30.2%) and trait (23.6%) anxiety were reported. Mood/anxiety disorder diagnosis was associated with all 3 symptoms. Atrial fibrillation symptom severity was associated with both depressive symptoms and trait anxiety. Heart failure diagnosis and digoxin use were also associated with depressive symptoms. Trends toward significance between state and trait anxiety and participant race/ethnicity as well as depressive symptoms and body mass index were observed. Study findings support associations between symptoms and quality of life, but not 6-month AF recurrence.

CONCLUSION

Depressive symptoms and anxiety are common in patients with AF. Healthcare providers should monitor patients with AF for depressive symptoms and anxiety at the time of procedures and intervene when indicated. Additional investigations on assessment, prediction, treatment, and outcome of depressive symptoms and anxiety in patients with AF are warranted.

EFFECTIVENESS OF TREATMENT WITH MEBICAR IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION

Violation of the heart rhythm is widespread at present. Anxiety-depressive symptoms and a tendency to chronic stress leads to the depletion of the body, which contributes to arrhythmia. The aim of the study is to assess the severity of clinical and hemodynamic indices by using anxiolytic drug mebicar. Materials and methods. Assessment of psycho-emotional status was studied using the psychosocial scale of stress by L. Reader, PSS-10 PHQ-15 and questionnaire identification of social factors that can affect health. Determination of cortisol level in serum was carried out by immunoassay (ELISA) on the ER-500 Microplate Reader. The concentration of N-terminal fragment of the brain natriuretic peptide precursor (NTproBNP) in serum was determined by ELISA using a Biosan PST-60HL shaker. Results. The results of the survey showed a direct dependence of the manifestation of atrial fibrillation (AF) on the level of psychoemotional stress. We found that in group 1b (standard treatment+mebicar) there were complaints of increased excitability (p<0.001), (p-reliability difference of indices before and after treatment), fatigue (p<0.001), deterioration of memory (p<0.01), appetite loss (p<0.05), sleep disturbance (p<0.001), signs of severe sweating (p<0.001), indicating the appearance of astheno-vegetative syndrome. The reduction of manifestations of high stress (p<0.01) in patients of group 1b (standard treatment+mebicar) was noted. A similar pattern was detected in the severity of anxiety in men (p<0.01). Conclusions. Application in the complex therapy of patients with stable coronary heart disease (SIHD) in conjunction with AF anxiolytics of the benzodiazepine series (mebicar) has allowed stopping anxiety-depressive disorders. Analyzing the level of cortisol, we observed its increase depending on the degree of anxiety and depression; NT-proBNT metrics are respectively.

Sex Differences in Quality of Life in Patients With Atrial Fibrillation: A Systematic Review

Background The goal of this literature review was to assess sex differences in the quality of life (QoL) in patients with atrial fibrillation ( AF ) and, if possible, to determine if these are due to AF . Methods and Results The electronic database PubMed was searched on January 23, 2018, using the search terms "QoL", gender differences, " AF " female, and gender to find potential articles that assessed sex differences in QoL in AF patients. In all, 851 articles were identified, from which 25 original studies were eligible for this systematic review. Female AF patients were found to have poorer QoL and more symptoms than male AF patients. They scored lower, predominantly on the physical component score of the Medical Outcomes Study Short-Form 36 Health Survey. Conclusions The available literature consistently describes poorer QoL in female AF patients but does not clearly address whether this is a reflection of sex differences seen in the general population or is related to AF per se. It is also questionable whether the relatively poorer QoL in women is large enough to be of clinical importance.

Effect of novel oral anticoagulants on Hospital Anxiety and Depression Scale scores

BACKGROUND

The negative impact of atrial fibrillation (AF) on health-related quality of life has been extensively documented. The aim of this study was to compare the Hospital Anxiety and Depression Scale (HADS) scores of patients with non-valvular AF during warfarin administration and after switching to novel oral anticoagulants (NOACs).

METHODS

The study comprised 100 consecutive patients on warfarin treatment between July 2018 and January 2019 for whom a transition to NOACs was planned. All patients completed the HADS at the start of the study and at least 3 months after that date.

RESULTS

The mean value of HADS-A (5.9 ± 2.1 vs. 4.4 ± 1.6, p < 0.001) and HADS-D (4.4 ± 1.7 vs. 3.7 ± 1.4, p < 0.001) scores was significantly higher in patients when they used warfarin than when they switched to NOACs. Analysis revealed that there was a significant correlation between HADS-A and HADS-D scores with age and history of bleeding (p < 0.001). The highest scores were found for patients with a history of bleeding and age ≥75 years (p < 0.001).

CONCLUSION

Our study demonstrates that patients with nonvalvular AF under treatment with NOACs had lower HADS-A and HADS-D scores compared with patients on warfarin treatment. These findings suggest that NOACs may increase the quality of life and decrease morbidity and mortality by reducing anxiety and depression.

Panic features strongly predict the subjective but not the objective benefit of pulmonary vein isolation

PURPOSE

Clinically observed discrepancies between electrocardiogram findings and subjective report of symptoms related to atrial fibrillation (AF) often remain unexplained. One could hypothesize that after a technically successful ablation, preoperative panic behavior might affect the report of AF-related symptoms. However, research on comorbid panic behavior in patients with AF is limited.

METHODS

In this observational prospective cohort study, we investigated psychological characteristics, in particular the prevalence of panic features, among 112 patients with AF and its possible influence on experienced outcome of subsequent ablation treatment.

RESULTS

Twelve percent of the AF patients (n = 12) were pre-operatively characterized by panic features. This group experienced higher levels of distress and more limitations in daily life compared to AF patients without panic features, but was not characterized by higher levels of neuroticism. However, AF-ablation resulted in a similar reduction of experienced limitations in daily functioning and levels of distress in both groups.

CONCLUSION

Patients with panic features experience more distress and more limitations in daily life from AF, but these complaints are reduced by AF ablation in a similar rate as in patients without panic features. Additional psychological therapy is suggested as a method to further reduce subjective AF disease burden in these patients.

Anxiety and Depression in Patients with Permanent Atrial Fibrillation: Prevalence and Associated Factors

Atrial fibrillation (AF) is an important public health problem that is increasing at an alarming rate, worldwide. The most common type is permanent AF followed by the paroxysmal and persistent AF. Purpose. This study was aimed at exploring anxiety and depression and the associated factors in patients with permanent AF. Materials and Methods. The sample of the study included 170 AF patients. Data collection was performed by the method of interview using the "Hospital Anxiety and Depression Scale" (HADS) to assess anxiety and depression and a questionnaire including patients' characteristics. Results. 70% of the participants were men, and 32.4% were above 70 years old. Furthermore, 34.9% of the patients had high levels of anxiety, and 20.2% had high levels of depression. Anxiety levels were statistically significantly associated with gender (p=0.022), age (p=0.022), educational level (p=0.025), years having the disease (p=0.005), and relations with nursing staff (p=0.040). Depression levels were statistically significantly associated with age (p=0.037), degree of information of the state of health (p < 0.001), years having the disease (p < 0.001), and relations with medical staff (p=0.041). Conclusions. Patients' characteristics are associated with anxiety and depression and need to be evaluated when treating this frequently encountered arrhythmia.

Feasibility and Usability of a Mobile Application to Assess Symptoms and Affect in Patients with Atrial Fibrillation: A Pilot Study

Background

Atrial fibrillation (AF) is the most prevalent arrhythmia leading to hospital admissions. The majority of patients with AF report symptoms that are believed to be associated with the arrhythmia. The symptoms related to AF traditionally are collected during a clinic visit that is influenced by biases associated with recalling the experience over a limited period of time.

Purpose

We designed this pilot study to assess the usability and feasibility of a mobile application to assess symptoms in patients with AF.

Methods

We designed a mobile application (miAfib) to assess symptoms (chest pain, palpitation, shortness of breath, fatigue, dizziness/lightheadedness), positive affect (happy, excited, content) and negative affect (worried, angry, sad) on multiple occasions throughout the day based on iOS platform. We performed a four-week feasibility trial to examine user adherence, acceptance and experiences with the mobile application. We administered questionnaires to assess factors affecting usage and self-reported acceptance of the application based on a five-point Likert scale with zero representing strongly disagree and 5 representing strongly disagree with.

Results

We included ten patients with paroxysmal and persistent AF. The mean number of completed assessments each day was 2.81 ± 1.59 with 94.7% of days with at least one assessment. The users found the application easy to use (4.75±0.46), intended to use it in the future (4.37±1.06) and found it easy to integrate into daily routine (4.5±1.07).

Conclusion

In this pilot study, we found participants in this four-week trial reliably used the application and were able to use the app to report their daily symptoms and affect regularly. Participants reported that they found the application easy to use and would consider using the application in the future.

Atrial fibrillation and psychological factors: a systematic review

BACKGROUND

Psychological factors have been suggested to have an influence in Atrial Fibrillation (AF) onset, progression, severity and outcomes, but their role is unclear and mainly focused on anxiety and depression.

METHODS

A systematic electronic search had been conducted to identify studies exploring different psychological factors in AF. The search retrieved 832 articles that were reviewed according to inclusion criteria: observational study with a control/comparison group; use of standardized and validated instruments for psychological assessment. Results were summarized qualitatively and quantitatively by effect size measure (Cohen's d and its 95% confidence interval). Cochrane Collaboration guidelines and the PRISMA Statement were adopted.

RESULTS

Eight studies were included in the systematic review. Depression was the most studied construct/ but only one study showed a clear link with AF. The remaining studies showed small and non-significant (95% CI [-0.25-1.00]) differences between AF and controls, no differences in frequency of depression history (95% CI [-0.14-0.22]) or in case frequency (95% CI [-0.50-0.04]). Miscellaneous results were found as far as anxiety: AF patients showed higher levels when compared to healthy subjects (95% CI [2.05-2.95]), but findings were inconsistent when compared to other heart diseases. Considering personality and life-events preceding AF, we respectively found a large (95% CI [1.87-2.49]) and a moderate to large effect (95% CI [0.48-0.98]).

DISCUSSION

The small number of studies does not allow to draw clear-cut conclusions on the involvement of psychological factors in AF. Promising lines of research are related to personality and adverse life-events, and to the increase of longitudinal design studies. Some methodological problems could be overcome by including clinical psychologists in the implementation of research protocols.

SF-36 total score as a single measure of health-related quality of life: Scoping review

According to the 36-Item Short Form Health Survey questionnaire developers, a global measure of health-related quality of life such as the “SF-36 Total/Global/Overall Score” cannot be generated from the questionnaire. However, studies keep on reporting such measure. This study aimed to evaluate the frequency and to describe some characteristics of articles reporting the SF-36 Total/Global/Overall Score in the scientific literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was adapted to a scoping review. We performed searches in PubMed, Web of Science, SCOPUS, BVS, and Cochrane Library databases for articles using such scores. We found 172 articles published between 1997 and 2015; 110 (64.0%) of them were published from 2010 onwards; 30.0% appeared in journals with Impact Factor 3.00 or greater. Overall, 129 (75.0%) out of the 172 studies did not specify the method for calculating the “SF-36 Total Score”; 13 studies did not specify their methods but referred to the SF-36 developers’ studies or others; and 30 articles used different strategies for calculating such score, the most frequent being arithmetic averaging of the eight SF-36 domains scores. We concluded that the “SF-36 Total/Global/Overall Score” has been increasingly reported in the scientific literature. Researchers should be aware of this procedure and of its possible impacts upon human health.

Symptoms In Atrial Fibrillation: A Contemporary Review And Future Directions

Atrial fibrillation (AF) is the most prevalent arrhythmia leading to hospital admissions in the United States. The majority of patients with AF report symptoms associated with this condition that can lead to a decrease in health related quality of life (HRQOL) and functional status. Therefore, along with reducing the risk of stroke and mortality, improvements in such symptoms are important therapeutic goals in the management of patients with AF. Our current understanding of how AF and symptoms are linked is hampered by the dominant assessment paradigm, where symptoms thought to be associated with AF are measured at a single point in time (frequently at a clinic visit). Unfortunately, this "static" snapshot does not capture the variability of symptoms and heart rhythm within a person over time and does not shed light on how symptoms are related to heart rhythm. This focused review summarizes current methods for assessing symptoms including generic and AF-specific HRQOL and functional status tools. It also describes gaps in the current assessment paradigm and where future research using mobile applications and digital technology might be able to assist with patient care.