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.