A novel, simple scale for assessing the symptom severity of atrial fibrillation at the bedside: the CCS-SAF scale.
BACKGROUND
The severity of symptoms caused by atrial fibrillation (AF) is extremely variable. Quantifying the effect of AF on patient well-being is important but there is no simple, commonly accepted measure of the effect of AF on quality of life (QoL). Current QoL measures are cumbersome and impractical for clinical use.


OBJECTIVE
To create a simple, concise and readily usable AF severity score to facilitate treatment decisions and physician communication.


METHODS
The Canadian Cardiovascular Society (CCS) Severity of Atrial Fibrillation (SAF) Scale is analogous to the CCS Angina Functional Class. The CCS-SAF score is determined using three steps: documentation of possible AF-related symptoms (palpitations, dyspnea, dizziness/syncope, chest pain, weakness/fatigue); determination of symptom-rhythm correlation; and assessment of the effect of these symptoms on patient daily function and QoL. CCS-SAF scores range from 0 (asymptomatic) to 4 (severe impact of symptoms on QoL and activities of daily living). Patients are also categorized by type of AF (paroxysmal versus persistent/permanent). The CCS-SAF Scale will be validated using accepted measures of patient-perceived severity of symptoms and impairment of QoL and will require 'field testing' to ensure its applicability and reproducibility in the clinical setting.


CONCLUSIONS
This type of symptom severity scale, like the New York Heart Association Functional Class for heart failure symptoms and the CCS Functional Class for angina symptoms, trades precision and comprehensiveness for simplicity and ease of use at the bedside. A common language to quantify AF severity may help to improve patient care.
Dorian
Paul
P
Division of Cardiology, St. Michael's Hospital, University of Toronto, Ontario, Canada. dorianp@smh.toronto.on.ca
Cvitkovic
Suzan S
SS
Kerr
Charles R
CR
Crystal
Eugene
E
Gillis
Anne M
AM
Guerra
Peter G
PG
Mitchell
L Brent
LB
Roy
Denis
D
Skanes
Allan C
AC
Wyse
D George
DG
D001281:Atrial Fibrillation / Q000145:classification* / Q000150:complications / Q000175:diagnosis*; D002170:Canada; D002309:Cardiology / Q000295:instrumentation*; D002637:Chest Pain / Q000209:etiology; D004244:Dizziness / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D006801:Humans; D019095:Point-of-Care Systems; D011788:Quality of Life; D012720:Severity of Illness Index; D012955:Societies, Medical