Validating a new quality of life questionnaire for atrial fibrillation patients
Introduction
Atrial fibrillation (AF) is the most common sustained arrhythmia observed in clinical practice and is associated with increased mortality and morbidity [1], [2]. The clinical impact ranges from completely asymptomatic subjects to others living extremely limited lives, the first manifestation being an embolic event or exacerbated cardiac failure [3]. Common symptoms include palpitations, breathlessness, chest pain and dizziness or fatigue [4]. AF patients frequently report general discomfort, low exercise tolerance, irritability, concentration deficit and sleep disorder. The optimal clinical management for AF is still unclear. The therapeutic arsenal, which includes anticoagulation, rhythm control, rate control, surgical and catheter ablation, pacemakers and, defibrillators, appears to be insufficient [5], [6], [7]. As a consequence, symptom relief and improving quality of life are often the primary goals of treatment [8], [9].
The definition of quality of life is inherently subjective; however, accurate quantification of quality of life has been proposed based on the use of two basic types of questionnaires, generic and disease-specific [9], [10], [11]. An appropriate questionnaire must evaluate a specific situation adequately, and be easy to use and understand [12]. A basic prerequisite is analysis of its validity, reproducibility and responsiveness in terms of psychometric properties [9], [10], [13].
Since 2000, a number of studies have evaluated AF patient quality of life using both generic and disease-specific instruments, but the questionnaires are not fully satisfactory [6], [14], [15], [16], [17], [18], [19]. The generic SF-36 questionnaire has been extensively used in the literature, but does not cover AF-specific manifestations. Despite the importance of AF, the University of Toronto Atrial Fibrillation Scale is the only questionnaire specifically designed for this arrhythmia, but covers only the symptom of palpitations.
We sought to develop an instrument for assessing AF patient quality of life that covered the main clinical manifestations and treatments and had properly tested measurement properties.
Section snippets
Initial phase
Three meetings were held with eight specialists certified by the Brazilian Society of Electrophysiology. First, the specialists determined the most important clinical manifestations of atrial fibrillation. To design the questionnaire it is useful to understand the difference between items, questions and domains, because quality of life is generally measured by a complex collection of items, questions, domains, and instruments. An item is a single question, and the domain identifies a particular
Clinical outcomes
Patients' clinical characteristics are shown in Table 1. Beta-blockers were the drug most frequently used by patients at all times during the study, except at 12 months, followed by amiodarone, digoxin and calcium antagonists. The drugs less frequently used at all times were sotalol, propafenone, and quinidine. ECG determined heart rhythm on each visit and a rhythm other than AF or sinus were called “other”. Heart rate monitoring with a 24-h Holter system, valid when performed up to one month
Discussion
The aim in developing a disease-specific QLAF was to assess the full range of AF, so we formulated questions covering the main clinical manifestations and treatments. Equally important, we tested the instrument's psychometric properties to show its validity, reproducibility, and responsiveness.
The QLAF questionnaire that we developed to evaluate the quality of life of patients with AF showed good agreement with the SF-36. However, in addition to requiring less time for its application, this new
Acknowledgement
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [28].
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