Validation of a new simple scale to measure symptoms in atrial fibrillation: the Canadian Cardiovascular Society Severity in Atrial Fibrillation scale.
BACKGROUND
Atrial fibrillation (AF) is commonly associated with impaired quality of life. There is no simple validated scale to quantify the functional illness burden of AF. The Canadian Cardiovascular Society Severity in Atrial Fibrillation (CCS-SAF) scale is a bedside scale that ranges from class 0 to 4, from no effect on functional quality of life to a severe effect on life quality. This study was performed to validate the scale.


RESULTS
In 484 patients with documented AF (62.2+/-12.5 years of age, 67% men; 62% paroxysmal and 38% persistent/permanent), the SAF class was assessed and 2 validated quality-of-life questionnaires were administered: the SF-36 generic scale and the disease-specific AFSS (University of Toronto Atrial Fibrillation Severity Scale). There is a significant linear graded correlation between the SAF class and measures of symptom severity, physical and emotional components of quality of life, general well-being, and health care consumption related to AF. Patients with SAF class 0 had age- and sex-standardized SF-36 scores of 0.15+/-0.16 and -0.04+/-0.31 (SD units), that is, units away from the mean population score for the mental and physical summary scores, respectively. For each unit increase in SAF class, there is a 0.36 and 0.40 SD unit decrease in the SF-36 score for the physical and mental components. As the SAF class increases from 0 to 4, the symptom severity score (range, 0 to 35) increases from 4.2+/-5.0 to 18.4+/-7.8 (P<0.0001).


CONCLUSIONS
The CCS-SAF scale is a simple semiquantitative scale that closely approximates patient-reported subjective measures of quality of life in AF and may be practical for clinical use.
Dorian
Paul
P
Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. dorianp@smh.toronto.on.ca
Guerra
Peter G
PG
Kerr
Charles R
CR
O'Donnell
Suzan S
SS
Crystal
Eugene
E
Gillis
Anne M
AM
Mitchell
L Brent
LB
Roy
Denis
D
Skanes
Allan C
AC
Rose
M Sarah
MS
Wyse
D George
DG
D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000523:psychology* / Q000628:therapy; D002170:Canada; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011788:Quality of Life; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires / Q000592:standards*