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European Society of Cardiology

Clinical Articles, Lead Article

Depression screening in AF clinics recommended

Patients with paroxysmal atrial fibrillation (AF) show signs of depression, sleeping disorders and low levels of physical activity, even in the absence of significant concomitant cardiac disease, according to results from the ANTIPAF Trial1 presented recently at the EHRA EUROPACE meeting in Athens, Greece.

Researchers led by Professor Karl Ladwig (Helmholtz Centre, Munich, Germany) set out to assess the degree of congruence between patient and physician assessment of the patients’ subjective health status which, the authors say, provides a good indicator of patient-physician communication and shared understanding.

Data for the analysis was taken for patients enrolled in the Angiotensin II Antagonist in Paroxysmal Atrial Fibrillation (ANTIPAF) trial. The ANTIPAF trial, conducted by Professor Andreas Goette within the German Competence NETwork on Atrial Fibrillation (AFNET), examined whether angiotensin II receptor blockers reduced the incidence of paroxysmal AF. The analysis also specifically explored discordance between AF patients and their doctors.

Professor Karl Ladwig (Helmholtz Centre, Munich, Germany)

Professor Karl Ladwig (Helmholtz Centre, Munich, Germany)

Between February 2004 and September 2008, 334 patients (41% female and 59% male) with paroxysmal AF, without significant concomitant heart disease, and their physicians from 43 participating centres were asked to rate the patients’ heath related quality of life (HRQoL). Patients filled in the SF-12 self rating scale in the clinic or home; while physicians complete the SF8 scale after the patient had left the clinic. Physicians had no access to the patient’s answer sheets.

Intra-Class Correlations (ICC) were used to assess the consistency or conformity of the measures made by multiple observers, and Bland Altman graphs plotted the strength of concordance for each patient against average ratings for both physicians and patients.

Results show physicians rated their patients’ health-related quality of life higher than patients, both for the mental component score (p<0.0001) and physical component score (p=0.001). Both the ICCs and Bland-Altman graphs showed unsatisfactory concordance. In the regression analyses, depression was significantly associated with discord in the mental component score (β=-0.94; p<0.001) and the physical component score (β=-4.13; p<0.002). Furthermore, sleeping disorders were associated with discord in the mental component score (β=-4.13; p<0.002) and physical activity with discord in the physical component score (β=-1.47; p=0.006).

“EPs generally decide whether to take a more or less aggressive treatment approach according to the patient’s disease burden. Here, not only physical symptoms need to be taken into consideration, but also the patient’s mental health and quality of life in general. If EPs don’t know that their patients are suffering from depression they may not be offering them optimum treatments,” said Professor Ladwig. “Good communication between physicians and patients is of paramount importance for adherence to medications and long term prognosis.”

“When one considers the importance placed on quality of life in the AF literature these levels of discordance between physicians and patients are surprisingly large. They underline the need for physician to be trained to recognize depression in patients and for the introduction of systematic screening for depression in all AF clinics,” he added.

Future studies should explore whether interventions such as physician training and screening, improve both quality of life and the underlying disease status of patients with AF, the authors said.

References
1. K Ladwig, A Eisenhart-Rothe, T Meinertz, et al. How well do electrophysiologists estimate the degree of quality of life impairment of their patients with paroxysmal atrial fibrillation? Results from the ANTIPAF Trial. Presentation FP 175 at EHRA EUROPACE.

Published on: July 30, 2013

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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