Who is More Likely to Experience AF Symptoms and Why?
Differences in AF symptom experience and severity trigger a number of questions about the correlates and processes involved. A recent meta-analysis suggested that women with AF report poorer QOL and more AF symptom.6 Similarly, sex differences were noted in the Zenger data and a variety of explanations could be posited, such as societal expectations and excess social stressors for women that may lead to the symptom differences between men and women.7 Women report significantly more severe symptoms, but may delay in seeking medical attention as a result of factors such as fear of troubling others with their symptoms, caregiving work, and social obligations.8 Although women are more likely to report their symptoms, cardiovascular symptoms are perceived by their providers as unrelated to their heart (53%) significantly more often when compared to men (37%).9 Collectively, these various processes may prompt women to be judicious in symptom reporting unless or until the symptoms are clearly troubling and interrupting of daily life.
The use of PROs has long been employed in assessing patient experience related to psychosocial functioning in other settings. The prevalence of anxiety and depression was recently found to be approximately 24% and 28% in AF samples3 and previously been shown to be associated with symptom severity, QOL and health care utilization.10,11 Depression has also been associated with a stepwise, progressively adverse change in outcomes of individuals with AF 12, highlighting the need for assessment and intervention among this population. Similarly, when clinical variables and psychological variables were assessed, only psychological function predicted AF symptom burden and QOL.13 The long-term management of AF is burdensome, and depression and anxiety are strongly associated with both treatment adherence and the subjective experience of the condition.12 The ambiguities of AF causes, symptoms, treatment options, and outcomes may contribute to a patient’s perception of their condition. Collectively, these studies highlight that there is not likely a “pure AF symptom experience”, but rather symptoms are interpreted through a lens affected by a broad set of factors, including co-morbidities such as psychological distress.