Study assesses factors that lead to inaccurate detection of frequency, duration of AF episodes

First-of-its-kind study published in HeartRhythm assesses various factors that lead to inaccurate detection of the frequency and duration of atrial fibrillation episodes

A new study shows how specific factors such as gender, age and mood disorders like anxiety and depression can lead patients with atrial fibrillation (AF) to inaccurately assess their heart rhythm.

The study, published in the April edition of HeartRhythm, the official journal of the Heart Rhythm Society (HRS), is the first-of-its-kind to evaluate demographics, health status and heart monitor data to identify specific factors that predict inaccuracies. Patients with persistent AF, women, older adults and those diagnosed with anxiety or depression were most likely to have inaccurate perceptions by either over-or-underestimating their AF symptoms.

Demographic and health status data were captured via questionnaires completed by 458 outpatients with documented AF. All patients wore continuous heart monitors for one week. Patients estimated the length and frequency of their AF episodes by completing the AF Symptom Severity questionnaire. Patient perceptions were compared to AF burden based on heart monitor results. Significant overestimators believed they were in near-continuous AF when their AF burden was less than 10 percent, while significant underestimators believed they had little to no AF when their AF burden was greater than 90 percent.

Fifteen percent of patients were found to be significant over-or-underestimators. Psychological comorbidities specifically anxiety and depression strongly predicted overestimating (5 percent), with anxiety being the stronger correlate of the two. Participants with persistent AF, female and older adults (mean 72.5 years old) were more prone to underestimating (9.8 percent) the length and frequency of their AF episodes.

“Oftentimes symptoms of AF can be difficult for patients to characterize. Some patients may have symptoms they think are due to AF, when in fact they may have another cause. Such misperceptions make it challenging to find appropriate and effective treatment options. Therefore, it’s crucial for patients to learn to check their pulse, learn what’s normal versus abnormal, and truly understand their heart rhythm,” stated co-lead author Anil Gehi, MD, FHRS, Associate Professor of Medicine/Cardiology, University of North Carolina Center for Heart and Vascular Care. “Our study results reinforce the importance of bettering patient understanding of AF. Improving communication with patients and educating them on the signs and symptoms of AF episodes could allow for a faster, more targeted treatment approach that would greatly enhance the quality of patient care.”

AF is the most common heart arrhythmia and affects more than 2.5 million American adults. The prevalence of AF is increasing rapidly, with projections to double by 2035 and to increase to 8 million by 2050. This study specifically sheds light on the comorbidities and features of AF that affect the presence of symptoms.